A Comparative Analysis of Laser Ablation vs. Conventional Surgery for Pilonidal Sinus Disease

REVIEWED BY Dr Reza Lankarani, General SurgeonFounder | Surgical Pioneering Newsletter and Podcast Series Editorial Board Member | Genesis Journal of Surgery and MedicineInternational Surgery Journal https://dx.doi.org/10.18203/2349-2902.isj20253005Int Surg J. 2025 Oct;12(10):1602-1606.--------------------------------------------------------------------------------1.0 Background and Study Objective1.1 Introduction to Pilonidal Sinus Disease (PSD)Pilonidal Sinus Disease (PSD) is an inflammatory condition that classically affects the sacrococcygeal region, the cleft at the top of the buttocks. The condition is widely understood to be acquired, with its primary etiology involving the penetration of loose hairs from the head, neck, and back into the natal cleft, which provokes a foreign body reaction. PSD predominantly affects males between the ages of 15 and 30. Key contributing risk factors include being overweight, engaging in extended periods of sitting, having dense body hair, a deep natal cleft, and a potential hereditary susceptibility. Notably, the source clarifies that personal hygiene has minimal impact on the development of the disease. Clinically, PSD can present with a range of symptoms, including pain or discomfort while sitting, persistent dampness or drainage from the affected area, and the development of acute abscesses.1.2 Current Treatment Landscape and Rationale for the StudyA diverse array of treatment options exists for PSD, yet no single approach is universally accepted as the standard of care. Conventional surgical methods include wide excision of the sinus with either primary midline closure or more complex flap reconstruction techniques. In recent years, minimally invasive techniques have gained prevalence, including endoscopic procedures (EPSiT, VAAPS), crystallized phenol application, and laser ablation.This study was designed to address the growing interest in minimally invasive options and the relative scarcity of direct comparative data for laser ablation. Despite promising initial results reported for laser techniques, significant uncertainty remains regarding the optimal management strategy for PSD. The specific objective of this research was to retrospectively evaluate and compare the clinical outcomes of laser ablation against two conventional surgical methods: surgical excision with direct closure (DC) and surgical excision with flap closure (FC). The study's methodology was designed to systematically compare these procedural and clinical outcomes.2.0 Study Methodology2.1 Study Design and Patient PopulationUnderstanding the methodological framework of this study is crucial for assessing the validity of its findings. The research was conducted as a retrospective analysis of patient data from a single academic institution, Ahalia Hospital Branch-1 in Abu Dhabi, UAE. The study period covered treatments administered between January 2010 and December 2021.A total of 288 patients who underwent surgery for PSD were included and categorized into three distinct treatment cohorts:* Laser Ablation (LG): 84 patients (29.2%)* Direct Closure (DCG): 112 patients (38.9%)* Flap Closure (FCG): 92 patients (31.9%)The study included patients aged 16 years or older with either primary or recurrent PSD. Patients with open wounds or those for whom delayed wound closure was planned were explicitly excluded from the analysis.2.2 Data Collection and Key EndpointsData were systematically collected from patient medical records, encompassing demographic information, operative details, and postoperative outcomes. The study's primary focus was on several key clinical endpoints, which were measured to compare the efficacy and safety of the three techniques:* Healing without events: Defined as complete healing without complications, residual disease, or recurrence.* Residual disease (RD): Incomplete healing or persistent disease identified at the two-month postoperative mark.* Recurrence: Reappearance of the disease after two months of initial healing.* Complications: Any adverse events following the procedure, such as infection, hematoma, or wound dehiscence.* Re-operations: The need for a subsequent surgical procedure.Statistical analysis was performed using SPSS software. The Mann–Whitney U test was used for continuous variables, while Pearson’s chi-squared test was used for categorical variables. A p-value of less than 0.05 was established as the threshold for statistical significance. This structured methodology allowed for a quantitative comparison of the procedural outcomes.3.0 Analysis of Key Findings3.1 Patient Demographics and Baseline CharacteristicsAnalyzing the baseline characteristics of the patient cohorts is essential for identifying any pre-existing differences that could potentially influence the study's outcomes. The demographic and clinical data for the three treatment groups are