Comparative approach for the treatment of pilonidal sinus: simple excision, sinotomy, and laser therapy

Pilonidal sinus disease (PND) is a chronic condition with a significant disease burden that commonly affects adolescents and young adults. Traditional approaches to treating PND include excision with midline closure, subcutaneous flap reconstruction, or healing by secondary intention. However, high postsurgical morbidity has led to the use of minimally invasive approaches. This study compares the medium- and long-term outcomes after treatment of PND with laser, surgical excision, and sinotomy.

An observational, retrospective, nonrandomized study of patients with PND was conducted between April 2022 and December 2024. The interventions included laser treatment, simple excision, and sinotomy. The primary outcome was the cure rate after surgery and the secondary outcome was failure rate.

Overall, 207 patients underwent surgery; 112 underwent laser treatment, 90 simple excision, and 5 sinotomy. The patient groups were comparable in baseline characteristics. There were no statistically significant differences in the cure rate or treatment failure among groups (p > 0.05). Complications were similar among groups (p = 0.88). Healing time was shorter with laser therapy and sinotomy than with simple excision (8 and 7 weeks, respectively, vs. 12 weeks, p < 0.05). Time to return to work was shorter in the laser group (3 weeks vs. 10 weeks for simple excision vs. 9 weeks for sinotomy, p < 0.05).

This comparative study of the most commonly used techniques in the treatment of PND demonstrates that laser provides much faster and more satisfactory postoperative recovery and return to work.