Relato de caso: primeiro caso de cisto pilonidal tratado com a técnica de Melpi (Minimum energy laser Pilonidotomy) no Hospital Universitário Clementino Fraga Filho (HUCFF)

Abstract

Pilonidal disease, first described by Richard Manning Hodges in 1880, is a skin condition in the sacrococcygeal region characterized by a cyst or sinus containing hair, typically in young, hirsute individuals. The traditional treatment is surgical, involving wide excision, which results in slow recovery, prolonged healing, and unsatisfactory cosmetic outcomes. In recent decades, minimally invasive techniques, such as LASER treatment, have gained attention, including methods like SiLaT, SiLaC, PiLaT, and the low-energy laser pilonidotomy (MELPi), described by Oliveira et al. in 2024.This study reports the case of a 16-year-old female diagnosed with a pilonidal cyst, treated with MELPi at the Clementino Fraga Filho University Hospital in April 2025. The surgery was performed under spinal anesthesia using a diode LASER 1470nm with a radial fiber and 8 J/cm energy. Transverse incisions were made, the fistulous tracts were curetted, and the LASER was applied for controlled ablation of the cavity. MELPi uses significantly lower energy compared to other laser approaches (8 J/cm vs. up to 200 J/cm), aiming to reduce pain, accelerate recovery, and minimize complications.The surgery lasted 30 minutes without complications, and the patient was discharged the same day, returning for follow-up on the 5th and 25th postoperative days. She reported immediate improvement, minimal pain, and no recurrence so far. Laser techniques have shown success rates of up to 97%, with low complication rates (3.3% to 25%). A key feature of MELPi is the possibility of reapplication if needed. Despite promising results, the main limitation of this study is the short follow-up period. Nevertheless, MELPi emerges as an effective and safe alternative with potential to become a standard option in selected cases.