Andreas Gruber on the Advantages of Treating Pilonidal Sinus with the Minimally Invasive SiLaC® Therapy
Andreas Gruber is a specialist in general surgery, visceral and special visceral surgery, as well as proctology. After many years of clinical practice in hospitals in Westphalia, Baden-Württemberg, Bavaria, and Austria, he has been self-employed in his own practice at the Landsberg Clinic since 2017. He is committed to integrating outpatient and inpatient surgery. For many years, he has also worked with the SiLaC® laser therapy from biolitec® for the treatment of pilonidal sinus.
What do you consider to be the most important advantages of SiLaC® laser therapy compared to conventional surgical methods for pilonidal sinus for patients?
The SiLaC® therapy offers several advantages for the patient.
Since only a lateral position is required for the procedure, a simple and lighter anesthesia can be performed, and in individual cases, surgery under local anesthesia is possible. The procedure can be performed on an outpatient basis in any case.
The surgery is minimally invasive and does not leave large complicated wounds. Healthy skin and adjacent tissue can be spared and even preserved. This results in significantly reduced pain perception and a shorter period of incapacity for work.
How does the SiLaC® treatment proceed in detail – from preparation to aftercare? What should patients pay attention to?
All patients are thoroughly informed about the procedure in advance. No actual preparation is required from the patient. The surgical area is shaved immediately before the procedure in the preparation room of the operating theater. During the procedure, all openings (fistula tracts) and the underlying cavity (sinus) are cleaned and then obliterated with the laser fiber. After the surgery, patients are provided with pain medication, which they can take if needed, and are seen by me on the first day after surgery and after 1 week in my practice. Intensive aftercare with daily elaborate dressings, as required by traditional surgical methods, is not necessary here. Simple dressing changes are sufficient. Any sick notes are issued as needed in my practice. It is important to minimize or even avoid prolonged sitting in the first 14 days.
For which patients is the SiLaC® therapy particularly suitable? Are there cases where you would advise against this method?
The therapy plan is made for each patient after individual consultation. Not every shoe fits everyone, but even in a recurrence situation, SiLaC® can be the right option.
What experiences have you had with the healing duration and healing chances after a SiLaC® treatment? How often do recurrences occur?
Generally, healing is expected within 3-5 weeks, with patients using a simple dressing that absorbs the minor discharges from the treated fistula openings, being able to live their usual daily life just a few days after the surgery. Restrictions are found in addition to sedentary activities, unfortunately also in recreational sports. The healing chances after laser surgery are superior to traditional surgical methods as no wound healing disorders can occur because no wounds are created. Recurrences after SiLaC® occur in about 10% of cases, whereas in traditional surgeries, the recurrence rate is about 20%.
How do your patients perceive the treatment and the time afterward in terms of pain, quality of life, and everyday suitability?
Patients are somewhat restricted in the first few days, pain medication is only required if necessary. After about 10 days, all patients are living their usual daily life again.
Are the costs for SiLaC® therapy covered by health insurance, and what should patients consider regarding cost coverage?
With the introduction of hybrid DRGs, I can offer the surgical laser therapy for statutory insured patients without costs to the patients. For privately insured patients, cost coverage is regulated.
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