Radiofrequency for the treatment of pilonidal disease: results of a French prospective pilot study

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PURPOSE: Minimally invasive techniques are increasingly applied in the management of pilonidal disease. While laser therapy is well established, radiofrequency (RF) represents a newer alternative with theoretical advantages. However, no prospective data have yet been published on its use. This study aimed to assess the safety, efficacy, and patient satisfaction associated with RF treatment for infected pilonidal sinus. METHODS: We conducted a prospective, single-center pilot study including consecutive patients treated with RF between March and December 2023. The procedure was performed under spinal or general anesthesia in an outpatient setting using a radial RF probe (25 W, 4 MHz) following mechanical debridement. Patients were followed up at 15 days and at 1, 3, and 6 months. The primary endpoint was safety; secondary endpoints included healing rate, predictors of failure, postoperative pain, return to activities, and patient satisfaction. RESULTS: Forty-four patients were enrolled (median age, 25.5 years; 31 men, 70.5%), of whom 38.6% had undergone previous surgery. The median operative time was 12 minutes. No major complications occurred, and minor early events were reported in 6.8% of cases. Complete healing at 6 months was achieved in 77.3% of patients. Failure and recurrence rates were 13.6% and 9.1%, respectively. A history of prior surgery significantly increased the risk of failure (odds ratio, 0.2; P=0.005). The median peak pain score was 2 out of 10, with a median duration of 2 days. Overall, 33 patients (75.0%) were very satisfied, and 40 (90.9%) stated they would undergo the procedure again or recommend it to others. CONCLUSION: RF appears to be a safe, minimally invasive outpatient treatment option for pilonidal disease, demonstrating promising efficacy, minimal postoperative pain, and high patient satisfaction. Trial registration: ClinicalTrials.gov identifier: NCT05855733.

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