Laser Ablasion Progress


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Hi everyone! I very recently received a laser ablasion surgery and wanted to provide some information to this community. I know that it can be difficult to find information about pilonidal sinus disease and various surgeries for it, so I want to be part of demystifying it! I'll try to update this post throughout my healing process. Because the surgery was so recent, I cannot speak to its efficacy yet. But keep your fingers crossed for me!

Background: 28 year old male. I have been managing PSD since fall of 2015. I've had it infected and lanced I would estimate between 7 and 10 times. Like many of you, the current information surrounding traditional open excision surgery completely deterred me. Last fall (2023), I had a consultation at Rush University with Dr. Govekar regarding the laser ablasion surgery. He described my case as pretty mild, with two sinuses and an abscess drainage tract. We set up a surgery date, I ended up having to reschedule for the end of January (2024). The surgery consists of opening up the sinuses using a trephine (tiny hole saw), removing debris, and destroying the diseased tissue with a laser diode. He said he has been doing the surgery sans laser for years and had great success with it. When he came to Rush, they asked if he'd be willing to give the laser a shot. He said he would gladly do that, he'd just never had access to it previously.

Surgery Day 1/30: Prep was pretty typical. Arrival at 6am, 8:15am surgery time. That two hours included registration, blood draw for tests, IV insertion. Eventually they moved me upstairs to the pre op room where I met my nurses, anesthesia team, and surgeon (Dr. Govekar). Could have been more, I was nervous! Once everyone had signed off, they started the sedative in my IV and I was wheeled to the operating room. I flipped onto the table and was out like a light. You are asleep for this procedure.

Next thing, I woke up in the recovery room. Now, I was told that I would be receiving a spinal anesthetic which would cause my lower half to be numb. Requiring a much longer recovery time. They said probably another two hours. They ultimately decided it wasn't necessary for my procedure, much to my delight as I wiggled my toes in recovery.

I was in zero pain at this point. Worst part was some throat pain and extreme thirst. Apparently I had thrown up while I was under anesthesia. Whoops! Once I was all cleared, they wheeled me down to the lobby, I met up with my fiancée, and we drove 3 hours home. I was totally coherent and able to move just fine with no pain. Left around 10:30am.

Day after Surgery 1/31: Woke up, still no pain. However, it is necessary to change the dressing each day. With some help from my loving fiancée, we removed the original dressing which consisted of iodoform packing, gauze, and a whole bunch of tape. No surprise, it bled a decent amount, but nothing ridiculous. I hopped in the shower and cleaned up the best I could and we replaced the dressing using the same materials. It is definitely hard to be as thorough with the packing as the surgeon is, but we do our best.

My fiancée was pretty surprised at how small the wounds are. In recovery, Dr. Govekar came by briefly to talk to me (very busy day for them). He said that there were two holes. One 3.5mm and the other he overlapped two punches to make a slightly larger hole. My partner just kept on saying she was shocked at how tiny the holes were. After redressing the wounds, I went about my day at home. I took the week off from work.

Progress to date 2/3: Each day has been pretty similar to the day following surgery. Very very little bleeding compared to the first day. Maybe a little discharge, but that might just be the iodine from the packing that I'm seeing on the gauze. In general, still no pain. I've gone to the farmer's market, run errands with my partner, gone for walks etc.

I did test my luck. I wore some khaki pants today compared to the sweats I've been wearing. And tried sitting at my desk for a few hours on the computer. I'm now pretty sore, but that was my own stupidity and still nothing to write home about.

Again, I cannot speak to the efficacy yet. But, if I'm fortunate enough to have a positive end result, I can't believe this isn't a standard first resort procedure for recurring PSD. The surgery was cake and so far, the recovery has been as well. I would gladly do it a second time if that's what it took. I welcome any questions you might have and I will do my best to update you as I continue recovering!