LASER EXCISION OF PILONIDAL SINUS (SILaC) - WITHOUT USING SCALPEL AT ALL!

 

Inflamed pilonidal (coccygeal) cyst is an inflammation of the pilonidal area between the buttocks, that causes pain and is often accompanied by a discharge of fluid through small holes in the skin (fistulas). Pilonidal cyst may be complicated by an abscess, which should be treated promptly with surgical drainage and resection of the cyst to prevent the spread of inflammation to the skin (fistula) or even worse to the coccygeal bone.

 

During excision of pilonidal Cyst with Laser (SILaC) , surgeon Savvas C Hirides first checks the course of the fistula using a special probe or saline (mapping of the fistular tracts). Then, through a small dilation of the existing openings of the fistula, doctor inserts a special scraper and carefully cleans the fistula and the cyst from its content (necrotic tissue, hairs). After being thoroughly cleaned, the fistular lining is cauterized sequentially with application of high energy Laser, resulting in the destruction of the inner wall of the abscess and the fistula without further incisions. The area is washed with plenty of saline. In rare cases and if local conditions do not allow the use of Laser, other, older techniques such as the  semi-closed method or Limberg or Karydakis flap surgery are performed. In severe or reoperated cases Dr Hirides may suggest use of Vacuum-Assisted Closure (VAC).

The new SILaC technique allows, through a microscopic incision, the photocoagulation of the inside of the bladder with LASER fiber optics and dramatically accelerates healing. Our patients state that they are excited about the result that allows them to leave the hospital even on the day of the operation and return to work within 3-4 days, without the need for painful and long-term trauma changes. Smaller fistulas may be treated in an outpatient basis under local anesthesia at the office.

Dr. Savvas C. Chirides is Assistant Professor of Surgery at the University of Nicosia. He works as a general surgeon at the Athens Medical Center and the American Medical Center in Nicosia. He completed the Postgraduate Program in Robotic Surgery of the Medical School of the National & Kapodistrian University of Athens with a scholarship for the title "Master of Science" (MSc) and received the title of Doctor of the University of Athens (PhD) with unanimous "excellent", for his research in Metabolic Surgery.

During his residency in the Second Surgical Clinic at the General State Hospital of Athens, Dr. Hirides gained extensive experience in the entire range of perianal diseases, mainly next to the pioneer of hemorrhoidectomy-guided-ultrasound in Greece, Dr. Paris Theodosiou, with whom he applied all the techniques known until then for the treatment of hemorrhoids (HAL hemorrhoidectomy, Laser hemorrhoidectomy, Ligasure, Rubber band,  Longo stapled hemorhoidopexy etc.). In the same clinic he was trained in the treatment of anal abscesses, simple and complex fistulas, anal fissure and in the open, closed and semi-closed technique of resection and reconstruction of the pilonidal cyst.

In January 2005, she successfully participated in the Postgraduate Seminar of the Medical School of Athens on Minimally Traumatic Techniques in Anorectal Cancer (IBEA).

After his residency, he completed the Master's Program in Minimally Traumatic & Oncological Surgery of the Medical School of the National & Kapodistrian University of Athens with a scholarship  for the title "Master of Science" (MSc) and received the title of Doctor of the University of Athens (PhD) for his research in Metabolic Surgery.

From January 2007 to August 2017, Dr. S.C. Hirides worked at the Clinic of General, Laparoscopic and Robotic Surgery of the Athens Medical  Center (Director: K.M. Konstantinidis), and actively participated in the first Greek Robotic Surgery Program with a total experience of more than 3500 operations. At the same time, she specialized in Robotics of Hernia, Upper and Lower Digestive and Robotic Surgery of Morbid Obesity - Metabolic Diseases.

As a doctor of the Medical Center's team, he was trained for 11 years in the development of hemoroidectomy-hemorrhoidoctomy HAL/RAR, THD and AngioDyn as well as in the use of ultrasound scissors and newer laser methods (HELLP, LHP, ELITE). There he also learned the techniques of anal fistulas restoration using Laser (FiLaC) and treatment of anal abscesses, and perianal fistulas. In this clinic he was also trained in the Karydakis techniques and its variants for the restoration of large deficits in the coccyx area, after resection of large capillary fistulas, as well as in the placement and therapeutic manipulations of VAC systems.

In September 2011 he successfully completed the Hands-On Course Transanal Endoscopic Microsurgery using EndoRec System in Nice, France. There, the doctor was trained in innovative endoscopic, transanal techniques for accessing diseases of the middle and lower rectum.

In October 2012 he completed the Postgraduate Seminar in Anorectal Surgery of the American College of Surgeons, in Chicago, USA.

In January 2013 he attended a training seminar in anorectal cancer surgery at the European Oncology Institute in Milan. In September 2016 he returned to the large oncology reference center of Italy as a guest speaker at the same training seminar.

Since May 2016, the great change brought about by the diode laser in surgical proctology has turned Dr. Hirides' team to widespread use of Laser in the operations of warts, pilonidal cyst (SILAC technique), anal fistulas (FILAC techniques) and hemorrhoidopathy (LHP technique).

In February 2021, the physician attended the Laser Proctology Postgraduate Seminar (FILAC and LHP) of Dr. Deska and Dr. Wolicki (Marien Hospital, Witten, Germany)

Dr. Hirides has  numerous publications in Greek and foreign journals, has taken part in the writing of many medical books  and participates as  an invited speaker in international Surgical conferences in Europe (Stockholm, Seville, Prague, Geneva, Turin, Brussels, Vienna, Limassol, Paris, Sofia, Bucharest, Amsterdam), America (Quebec, Chicago, Boston, San Diego, San Francisco) and Asia (Beijing).

He is a member of the Hellenic Surgical Society, the European Society of Laparoendoscopic Surgery (EAES), the International Society of Robotic Surgery (SRS), and the American College of Surgeons (title FACS).  

Today he performs operations from the entire spectrum of General Surgery (surgery of abdominal wall hernia, hiatal hernia and reflux disease, stomach, gallbladder, small and large intestine, anal and perianal diseases and morbid obesity) in Greece and Cyprus. His patients say they are completely satisfied with both the choice of robotics and the choice of the robotics surgeon Dr. Savvas C.Hirides.