SiLaT: A paradigm shift in the treatment of pilonidal disease?

BACKGROUND: Pilonidal disease (PD) is a common condition for which the global incidence is increasing. Surgery is the currently preferred approach to treatment but there is a growing interest in new minimally invasive techniques, such as sinus laser therapy (SiLaT). AIM: Our primary objective was to assess the efficacy of SiLaT for the treatment of pilonidal disease. The secondary objectives were to evaluate morbidity and patient satisfaction and identify predictive factors of success. METHODS: All adult patients, who underwent SiLaT in our department for a primary or recurrent pilonidal sinus from June 1, 2018, to December 31, 2020, were included in the study. Healing was defined as the closure of cutaneous orifices and the absence of seepage or abscesses. RESULTS: In total, 111 consecutive patients, for whom the male/female sex ratio was 2.1 and the mean age 28.8 (± 9.4) years, were included in this study. Eighteen (16.2%) patients had already undergone prior surgery for PD. The mean follow-up was 339.2 (± 221.4) days. A healing rate of 78.4% was observed, with a median time to healing of 20.0 days (15.0-30.0). The median time to return to usual activities was three days (1-7). The only postoperative complication was bleeding, which occurred for two patients (1.8%). Eighty-two patients (88.2%) reported being "very satisfied" with the treatment. Multivariate analysis showed no predictive factors for healing among the studied variables. CONCLUSION: SiLaT is an efficient and safe procedure for the treatment of PD, with a high level of patient satisfaction. It will now be necessary to position it within the therapeutic algorithm.

Is routine pathologic evaluation of hemorrhoidectomy specimens necessary?

AIM: To confirm that systematic histological study of hemorrhoidectomy specimens is useless, as is proposed by the French Society of Coloproctology (Société Nationale Française de Colo-Proctologie) under the sponsorship of the French National Health Accreditation and Evaluation Agency (Agence Nationale d'Accréditation et d'Evaluation en Santé). METHODS: Retrospective histological analysis of hemorrhoidectomy specimens obtained in a coloproctology unit between January 1, 1985 and December 31, 2001. RESULTS: We found 56 histological abnormalities (0.69%) among 8153 hemorrhoidectomy specimens considered normal at gross examination, with three cases of intraepithelial neoplasia of the anal canal (0.04%) and four cases of severe dysplasia (0.05%). Specimens associated with anal fissure (N = 906) or suppuration (N = 610) did not display more histological lesions. For all patients, the initial surgical resection prevented recurrence. CONCLUSION: Routine pathological evaluation of hemorrhoidectomy specimens is not useful and is expensive. All operating procedures in proctology should reflect this attitude. It is nevertheless advisable to select for gross and microscopic evaluation any suspicious areas noticed at the preoperative examination or during the procedure.