biolitec® in Coloproctology

Minimally invasive laser therapy of pilonidal cysts


FiLaC® laser therapy now also available for the treatment of pilonidal cysts


Unlike anal fistulas, pilonidal cysts are caused by an external trigger, Cologne-based FiLaC® specialist Dr. Arne Wilhelm explains. Pilonidal cysts are especially aggravating as they appear in the area of the gluteal cleft and do not heal by themselves. Without effective treatment they can considerably diminish the patients’ quality of life.


Dr. Wilhelm, what symptoms do occur?

The affected area is partially reddened, swollen, and reacts on pressure. Sitting, walking, and lying become painful. In many cases, purulent and bloody liquid is secreted out of the fistula orifice.


And how do pilonidal cysts develop?

We know of congenital fistulas that already appear in toddlers. Yet, fistulas occurring in the later course of life are acquired. In theory, hair roots in the gluteal cleft become “inflamed” due to pressure and tension. Fistula tracts develop within the skin and lead into the subcutaneous fat tissue. There they kind of “communicate” with one another, and single hairs are being trapped.


Dr. Wilhelm, what therapeutic options do exist?

This disease can be healed by surgery alone. Nowadays, the classic excision of pilonidal cysts is the most common treatment method: Skin layers are generously removed, often as deep as the periosteum of the coccyx. That means that not only the pilonidal cyst itself is cut out, but also surrounding tissue. This results in prolonged hospital stays and wound healing that takes several weeks, sometimes even months.

We prefer a minimally invasive surgical procedure based on the so called “Pit Picking” in combination with FiLaC® laser therapy. Applying these two methods leads to significantly smaller wounds, less pain and a shorter period of recovery.


How does "Pit Picking" work?

With Pit Picking, only the fistulas’ orifices are sparingly cut out. If necessary, the abscess or granulation cavity is drained to the side, and the trapped hairs are removed. Thus, large wounds at the gluteal cleft are avoided. This is especially beneficial as wounds in this area normally tend to heal poorly and much slower due to the skin’s higher tension.


What is the advantage of FiLaC® laser procedure?

This procedure is mostly applied when treating long fistula tracts under the skin. The FiLaC® probe is inserted into the fistula tract where it irradiates laser energy to precisely atrophy the fistula tissue and the remains of trapped hairs. The surrounding tissue is neither harmed, nor has to be removed. As a result, wound healing is considerably shortened.


What is the estimated cure rate?
With Pit Picking, the primary cure rate is approximately 80 percent. In combination with the FiLaC® laser procedure we achieve cure rates of more than 92 percent in our practice.


What do you recommend for the time following surgery?
We think the permanent medical removal of body hair is the easiest and best way to avoid recurrence.