Sinus-Fistula Ablative Contraction Intracavity Laser (S-FACIL Technique)

Aim:  Treatments of pilonidal disease should not be more disabling for the patient than the disease itself. Because of the wide range of surgical options available, the surgeon treating pilonidal disease should master 3–4 approaches that are applicable to a wide range of disease presentations. Simple tract unroofing and curettage are helpful and the most popular option in the setting of minor disease. However, healing time and discomfort are high. Potential advantages of non-excisional therapies are more rapid recovery and less post-procedural pain. The objective of the video is to give a step-by-step description of the laser-based treatment of this frequent proctological pathology. We have named this technique according to our protocol S-FACIL (Sinus-Fistula Ablative Contraction Intracavity Laser).

Methods: We present the case of a young man with a diagnosis of standard pilonidal sinus and an indication for treatment in our institution. S-FACIL was applied under spinal anesthesia after a small skin incision of 0.5 cm in every pit with the help of a punch and careful cleaning of the sinus tracts with a curette and peroxide. A radial fiber connected to a diode laser set at the wavelength of 1470 nm was then introduced into the tracts. The laser energy was delivered  at 12W with 8-second pulses and 1-second pauses between pulses. The procedure was performed on an outpatient basis with subsequent home cures based on Prontosan®and Aquacel®for 4 weeks.

Outcome: The concept of action of this technique is the contraction of the tissue radiated with laser technology in order to eliminate the cavity and avoid a large excisional scar. 

There are few descriptions of this technique with procedural variations and laser parameters with promising initial results.1 Operative time was 20 minutes with no intra or postoperative complications and the patient achieved complete healing at 6 weeks with minimal deterioration in his daily activity.

Conclusion: Potential advantages of modern techniques based on cutting-edge technology like S-FACIL are more rapid recovery and greater comfort.