Minimal Surgery for pilonidal disease,
Trephine, Endoscopic, Laser & Phenol
In recent decades, advanced alternatives to traditional wide excision have developed, with minimal damage to healthy tissue, faster recovery, and a better aesthetic result.
Minimal surgery with targeted removal of each pilonidal opening
1. Pilonidal Minimally invasive surgery with Trephine (Trephine/Punch Operation)
The minimal method for treating pilonidal disease was published in 2008. The treatment involves using thin perforators (trephines, punches) for separate punctate excision of each of the skin openings and the channels leading from them to the subcutaneous cavities and cleaning the cavities of hair and inflammatory content that accumulated in them. This treatment removes in a targeted manner the disease factors (openings, channels and hair), without the need for wide and unnecessary excision of surrounding healthy tissue. Due to the minimal tissue excision, no aesthetic damage is caused and compared to traditional wide excision, recovery with the minimal method is incomparably faster and easier. The procedure is possible under local anesthesia, without the need for hospitalization, and the average healing time is 2-4 weeks. In case of disease recurrence (about 20%), the same treatment can be repeated.
Additional names for the minimal method: Lord & Millar operation, Bascom "pit picking" operation, Gips "trephine/punch" operation.
Excision of a pilonidal pit using a 4mm trephine and extracting hairs from the sinus.
The picture shows the punching tools (trephines), used to remove each pit and subcutaneous tracts.
2. Video-Assisted Endoscopic Treatment
A minimally invasive technique published in 2014, combining punctate excision technology of openings using trephine with endoscopy for visualization of the pilonidal cavity. Endoscopes are thin tubes with a camera and light at their ends. The endoscope is inserted into the subcutaneous pilonidal cavity and allows removal of hair and debris from the cavity under direct visual control. Through the endoscope, it is also possible to cauterize the cavity walls using electric current or laser beam.
3. Laser Treatment
A cauterization technique performed without the need for an endoscope. The method includes excision of openings and channels and cavity cleaning as in trephine surgery, insertion of an optical fiber into the pilonidal sac and activation of a laser beam through it to cauterize the sac walls and cause its contraction.
Modern minimally invasive surgeries for pilonidal disease represent significant progress in the treatment of the phenomenon. Treatment with a trephine is one of the minimally invasive methods for treating pilonidal disease. For patients with mild and moderate disease conditions, the treatment is an effective and comfortable solution with minimal damage to the quality of life. Endoscopy and laser methods are based on trephine surgery and aim to optimize the cleaning of the pilonidal space. However, they require expensive resources and equipment to operate, which are not always available, and ongoing medical research is required to prove their advantage in curing the disease in the long term.
4. Phenol Injection Treatment
An old treatment based on chemical cauterization to destroy the pilonidal cavity. The treatment is performed by injecting carbolic acid (phenol) into the sac cavity, as a single treatment or as a complement to trephine surgery. The treatment often requires multiple injection sessions and is not widely used by surgeons.