This video demonstrates a minimally invasive technique for the treatment of pilonidal sinus using a 1470 nm diode laser. The procedure includes tract irrigation, mechanical debridement, widening of the external opening, and laser ablation of the sinus tract. This approach allows effective obliteration of the tract with minimal bleeding and excellent postoperative recovery.
Case Description:
A32 ys old male patient presented with a pilonidal sinus located in the sacrococcygeal region. The procedure was performed under spinal anesthesia with the patient in the prone position.
Procedure:
The sinus tract was initially irrigated with hydrogen peroxide to clear debris and organic material. This was followed by antiseptic preparation using povidone-iodine, and subsequent irrigation with normal saline.
Mechanical debridement of the tract was performed using a curette to remove granulation tissue and epithelial lining. The tract was then irrigated again with normal saline.
The external opening was gently widened using a curette to facilitate insertion of the laser fiber and ensure adequate drainage postoperatively .
Laser ablation was performed using a 1470 nm diode laser at a power setting of 8 watts. The sinus tract measured approximately 3 cm in length and 5 mm in diameter. The laser fiber was gradually withdrawn while delivering uniform energy to achieve complete ablation of the tract lining.
Hemostasis was achieved effectively after minimal to mild bleeding. The cavity collapsed almost completely following laser application.
Operative Time:
Approximately 30 minutes
Outcome:
The patient tolerated the procedure well and was in excellent condition postoperatively, with effective hemostasis and near-complete closure of the cavity.
Background: Pilonidal sinus disease (PNS) commonly affects young adults and is associated with pain, discharge, and impaired quality of life. Minimally invasive laser techniques aim to ablate the sinus tract with reduced morbidity.
Objective: To present the technique and short-term outcomes of 1470-nm diode laser ablation for PNS.
Methods: A 32-year-old male with symptomatic PNS underwent laser ablation. The tract was irrigated, mechanically debrided, the external opening widened, and endoluminal laser ablation was performed (1470 nm, 8 W). Operative details and early postoperative outcomes were recorded.
Results: Operative time was 30 minutes with minimal bleeding. The sinus tract (3 cm length, ~5 mm diameter) collapsed after laser application. The patient had an uneventful recovery, reporting only mild pain controlled with oral analgesics and no discharge at 3 weeks.
Conclusion: 1470-nm diode laser ablation is a safe, minimally invasive option for selected PNS cases, offering effective tract obliteration, minimal bleeding, and rapid recovery. Larger series with longer follow-up are warranted.
Pilonidal sinus disease is a chronic inflammatory condition of the sacrococcygeal region, often affecting young males. Traditional surgical options—wide excision with secondary healing or flap procedures—can be associated with significant morbidity, prolonged wound care, and delayed return to normal activity.
Minimally invasive approaches, including endoscopic and laser-based techniques, have been introduced to reduce tissue trauma and accelerate recovery. The 1470-nm diode laser targets water-rich tissues, providing controlled photothermal ablation and coagulation within the sinus tract. This report describes the operative technique and early outcome of laser ablation in a symptomatic patient.
Study Design: Single-patient case report with operative video documentation.
Patient: A 32-year-old male presenting with sacrococcygeal pain consistent with PNS. No acute abscess at presentation.
Preoperative Assessment: Clinical examination identified external openings in the natal cleft; no active purulent discharge at the time of surgery. Routine preoperative evaluation was unremarkable. Informed consent was obtained.
Operative Technique:
• Position & Anesthesia: Prone position under appropriate anesthesia. Standard sterile preparation and draping.
• Identification of Tract: External opening(s) identified.
• Irrigation Sequence: Hydrogen peroxide irrigation to clear debris, followed by povidone-iodine antisepsis, then copious normal saline irrigation.
• Mechanical Debridement: Thorough curettage of the sinus tract to remove granulation tissue and epithelial lining.
• Widening of External Opening: Gentle enlargement using a curette to facilitate drainage and laser fiber प्रवेश.
• Laser Ablation: A 1470-nm diode laser fiber introduced into the tract. Energy delivered at 8 W in a continuous/controlled fashion while gradually withdrawing the fiber to achieve circumferential ablation of the tract epithelium.
• Tract Dimensions: Approximately 3 cm in length and ~5 mm in diameter.
• Hemostasis: Achieved with minimal bleeding; no sutures required.
• Postoperative Care: Simple dressing; oral analgesics as needed; hygiene advice and hair control.
• Outcome Measures: Operative time, intraoperative bleeding, immediate complications, pain control, and presence/absence of discharge at 3 weeks.
• Operative Time: ~30 minutes.
• Intraoperative Findings: Effective ablation with near-complete collapse of the tract.
• Bleeding: Minimal; hemostasis achieved without difficulty.
• Complications: None intraoperatively or in the immediate postoperative period.
• Recovery: Patient discharged in same day in stable condition.
• Follow-up (3 weeks):Mild pain only, controlled with oral analgesics; no discharge; satisfactory local healing; return to daily activities without limitation.
Minimally invasive management of PNS has gained popularity due to reduced tissue trauma and faster recovery compared with wide excision or flap-based procedures. The 1470-nm diode laser is well suited for endoluminal ablation because its wavelength has high absorption in water, enabling controlled photothermal effects that denature the epithelial lining and coagulate small vessels, thus promoting tract closure with minimal bleeding.
In this case, a standardized sequence—irrigation, mechanical debridement, widening of the external opening, and controlled laser withdrawal—resulted in effective tract obliteration and early symptom resolution. The absence of discharge and the presence of only mild, analgesic-controlled pain at 3 weeks are consistent with reports describing favorable early outcomes of laser therapy.
Compared to conventional excision, laser ablation may offer: (1) shorter operative time, (2) minimal bleeding, (3) reduced postoperative pain, and (4) quicker return to normal activity. However, limitations include the need for appropriate case selection (non-acute, well-defined tracts), operator experience, and the current lack of long-term, high-level evidence in large cohorts. Recurrence rates and long-term durability should be evaluated in prospective studies with standardized follow-up.
The author declares no conflicts of interest.
The author thanks the operating room staff and nursing team for their assistance during the procedure. No external funding was received for this work.
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