Interview with Dr. Thomas Deska
"See a doctor immediately if it itches and oozes" – Outpatient treatment for pilonidal cysts possible
Dr. Thomas Deska is the Senior Consultant of General and Visceral Surgery at the Clinic for General and Visceral Surgery at the Marien Hospital Witten. He has specialist training in General Surgery, Visceral Surgery, and Special Visceral Surgery with an additional qualification in Proctology. The surgical specialty clinic is also certified as a Competence Center for Surgical Coloproctology by the German Society for General and Visceral Surgery (DGAV).
Dr. Deska, since when have you been working with the laser method SiLaC®?
We at Marien Hospital started treating anal fistulas with the biolitec® laser system in 2011. After half a year, we expanded this to pilonidal cysts and hemorrhoids. SiLaC® (Sinus Pilonidalis Laser Closure) is the term for the treatment method by biolitec® for pilonidal cysts.
How many patients do you treat with the laser method?
Regarding anal fistulas, pilonidal cysts, and hemorrhoids, we operate on between 200 and 300 patients per year.
What exactly are pilonidal cysts?
Pilonidal cysts (medically "Sinus Pilonidalis") are acute or chronic inflammations in the area of the lower back and coccyx region. Here, bacteria have penetrated the skin and caused an inflammation. Initially, the body tries to expel the inflammation by forming one or more channels (fistulas). If left untreated, an abscess – a cavity filled with pus – forms over time.
How can patients notice that they are developing a pilonidal cyst?
If it repeatedly itches and oozes a little, patients should not hesitate to have a proctologist clarify the cause. If it is a fistula, but the ultrasound examination confirms that no abscess has formed yet, this problem can usually be resolved relatively quickly and easily with the SiLaC® laser method in a single procedure within a few minutes. This procedure causes minimal damage to surrounding tissue and is generally bloodless. Afterward, the patient can usually go home directly.
However, if pressure pain is added and sitting becomes uncomfortable or even impossible, no more time should be lost! This already indicates the formation of an abscess, which must be operated on as soon as possible! We encounter this situation in about 70% of the patients who present to us.
How is the operation carried out?
It is important to know that the treatment of a pilonidal cyst with an abscess is a multi-stage procedure. First, in an outpatient procedure under spinal anesthesia or general anesthesia, the abscess is incised (split), cleaned, and flushed. The inflamed glandular tissue (epithelium) inside the abscess cannot be broken down by the body itself. Then the patient receives an antibiotic for 10 days against the inflammation. After this period, the patient returns to us at the clinic, and the SiLaC® laser method is used. We irradiate all fistula tracts (pits) with the laser, which closes them. The reduced fistula cavity is cleaned again to completely remove all residues. The wound is not sutured afterward but remains open to prevent new inflammation sites from forming.
What about patients who have already undergone surgery?
It is essential to consider that conditions like pilonidal cysts can recur. The causes are varied, and there is little that can be done against hormonal changes or inherited predispositions. It is important to know that both patients with recurrent pilonidal cysts and patients with wound healing disorders after previous surgeries can be treated.
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