Changes in temperature fields and microcirculation in the walls of pilonidal cysts of the coccygeal region during and after laser-induced thermotherapy

Introduction. To date, many options for conservative and surgical treatment of patients with pilonidal cysts have been developed. Our studies on the use of laser radiation in the treatment of epithelial coccygeal passage, which began in 2007, showed its positive clinical effect, which is expressed in a decrease in the number of complications and relapses. The essence of the method lies in the thermal ablation of the walls of the coccygeal passage with laser radiation.

Aim. To study the effect of high-intensity laser radiation on the tissues of the pilonidal cyst in patients with epithelial coccygeal passage, in order to improve the results of treatment in this category of patients.

Materials and methods. The study was conducted for the period from 2018 to 2021. The patients were divided into 2 groups depending on the type of surgical treatment. The first group consisted of 124 patients who underwent traditional excision of the pilonidal cyst with primary sutures. The second group included 60 patients who underwent laser-induced interstitial thermotherapy (LIIT). To study microcirculatory changes in the tissues of the pilonidal cyst area at the time of the surgical injury, the Spectrotest apparatus was used.

Results. The analysis of research materials was carried out in two statistically homogeneous groups. During dynamic studies, we have established certain changes in the parameters of microcirculation and tissue saturation, depending on the type of surgical treatment performed. After the operations in the first group, there was a significant violation of microcirculation, and hence tissue saturation in the walls of postoperative wounds. In the second group of patients, microcirculatory disorders were less pronounced, and their normalization occurred much earlier. Thus, a decrease in the volumetric rate of capillary circulation and tissue saturation in this group of patients practically did not occur. This indicates the absence of ischemia of the surrounding tissues around the treated area. When measuring temperature fields in the walls of pilonidal cysts in LIIT, temperatures were set from 56 to 65°C, i.e. the temperature of destruction of proteins included in the structure of the cyst walls. On the surface and in the tissues surrounding the cyst, the maximum recorded temperature is 40°C, and this does not lead to destruction, which is also confirmed by morphological data.

Conclusions. High-intensity laser radiation leads to obliteration of the cystic cavity, the formation of scar tissue, the elimination of specific symptoms and a decrease in the risk of recurrence of pilonidal disease, which is confirmed by spectroscopy, thermometry and histological studies.

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