EP306 - In-Office Laser Treatment of Pilonidal Disease and Anal Fistulas: A Series of 60 Cases

Purpose/Background: Pilonidal cysts and anal fistulas are common anorectal disorders associated with significant morbidity and recurrence. Conventional surgical treatments often lead to prolonged healing, high recurrence rates, and significant patient discomfort. In recent years, minimally invasive laser therapies have gained attention as promising alternatives. Sinus Laser Ablation of the Cyst (SiLaC) for pilonidal disease and Fistula Laser Closure (FiLaC) for anal fistulas are novel techniques that use radial-emitting laser fibers to ablate the epithelialized tract from within, aiming to preserve sphincter function and reduce morbidity.

Methods/Interventions: This prospective, single-center study will enroll 60 adult patients, divided into two cohorts: 30 patients with pilonidal cysts and 30 with cryptoglandular anal fistulas. Inclusion criteria include age 18-65, diagnosis confirmed by clinical examination and imaging (MRI for fistulas). Exclusion criteria include Crohn's disease, malignancy, or prior radiation to the pelvis.

Pilonidal cohort: Patients will undergo SiLaC under local or spinal anesthesia. The sinus tract will be cleaned and debrided, followed by insertion of a 1470 nm radial laser probe and circumferential ablation.

Fistula cohort: Patients will undergo FiLaC using the same laser system. The fistula tract will be cleaned, and the internal opening closed with an advancement flap or suture, followed by laser ablation of the tract.

Primary outcomes include healing rate at 3 and 6 months, recurrence rate at 12 months, and postoperative pain scores. Secondary outcomes include operative time, return to daily activity, and complication rates.

Results/Outcomes: During the 1 year period between October 2024-October 2025, 60 patients were treated in-office with the Neolaser device. In the pilonidal disease arm, the majority of the patients were male, which was the same in the anal fistula arm. The average patient age was 36. There was an 85% success rate for pilonidal disease and 95% for anal fistula ("success" defined as no recurrence or need for repeat procedure).

Conclusion/Discussion: Previous studies have looked at both SILAC and FILAC in limited series, and none have looked at both procedures being done primarily in the outpatient office setting. Performing these procedures in the office is often preferable for the patient, resulting in less recovery time, less time off work, and overall less out-of-pocket costs. This mixed series of 60 pilonidal disease and anal fistula patients shows that in-office treatment of these conditions with laser ablation is feasible and effective. Future studies will be needed to evaluate long-term outcomes and cost-effectiveness.