Beyond the scalpel: post-operative outcomes of radial diode laser ablation in sacrococcygeal pilonidal sinus disease

Ashtha Singh; G. D. Yadav; Anju Yadav

doi:10.18203/2349-2902.isj20263285

Authors

Ashtha Singh Department of General Surgery, Ganesh Shankar Vidyarthi Memorial (GSVM) Medical College and Lala Lajpat Rai Hospital, Kanpur, Uttar Pradesh, India
G. D. Yadav Department of General Surgery, Ganesh Shankar Vidyarthi Memorial (GSVM) Medical College and Lala Lajpat Rai Hospital, Kanpur, Uttar Pradesh, India https://orcid.org/0009-0005-6743-4166
Anju Yadav Department of Paediatrics, ESIC Hospital, Jajmau, Kanpur, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2349-2902.isj20263285

Keywords:

Body mass index, Diode laser, Hair density, Pilonidal sinus, Sedentary occupation, Wound healing

Abstract

Background: Conventional excisional surgery for sacrococcygeal pilonidal sinus disease repays cure with weeks of open wound care. This study evaluated post-operative outcomes of 1470-nm radial diode laser ablation and the factors governing healing.

Methods: Fifty consecutive patients underwent curettage and 1470-nm radial diode laser ablation at 10 W in a prospective observational study in Kanpur, India, between October 2024 and February 2026. Age, sex, body mass index, family history, morphological stage, occupational sitting duration, gluteal hair density and hair shaft thickness were tested against healing time, delayed healing beyond 30 days and six-month recurrence, univariably and by multivariable linear regression.

Results: Mean age was 25.0±5.3 years and 42 patients (84.0%) were men. Mean operating time was 26.1±8.7 minutes, hospital stay 1.3±0.5 days and day-7 pain 1.2±0.8. Mean healing time was 28.5±10.2 days; 46 patients (92.0%) had no complication and three (6.0%) recurred. Healing time rose with stage (20.1 to 43.5 days; F=22.19, p<0.001), sitting duration (F=5.37, p=0.008), body mass index (r=0.344, p=0.014) and hair density (F=3.61, p=0.035). Delayed healing was associated with advanced stage (76.5% versus 3.0%), overweight (77.8% versus 17.1%), sitting beyond six hours daily (54.5% versus 7.1%) and dense gluteal hair (53.3% versus 17.1%; all p≤0.016). Hair shaft thickness predicted nothing. On multivariable regression only stage remained independent (B=5.60 days per stage, p<0.001; R²=0.737). No factor predicted recurrence.

Conclusions: Laser ablation achieved day-care surgery with minimal pain and 6.0% recurrence. Morphological stage governed healing; body mass index, sedentary work and hair density acted through it.

References

de Parades V, Bouchard D, Janier M, Berger A. Pilonidal sinus disease. J Visc Surg. 2013;150(4):237-47.

Segre D, Pozzo M, Perinotti R, Roche B. The treatment of pilonidal disease: guidelines of the Italian Society of Colorectal Surgery (SICCR). Tech Coloproctol. 2015;19(10):607-13.

Vartanian E, Gould DJ, Lee SW, Patel KM. Pilonidal disease: classic and contemporary concepts for surgical management. Ann Plast Surg. 2018;81(6):12-9.

López JJ, Cooper JN, Halleran DR, Deans KJ, Minneci PC. High rate of major morbidity after surgical excision for pilonidal disease. Surg Infect. 2018;19(6):603-7.

Meinero P, Stazi A, Carbone A, et al. Endoscopic pilonidal sinus treatment (EPSiT). Colorectal Dis. 2016;18(5):164-70.

Milone M. Safety and efficacy of minimally invasive video-assisted ablation of pilonidal sinus: a randomized clinical trial. JAMA Surg. 2016;151(6):547-53.

Pappas AF, Christodoulou DK. A new minimally invasive treatment of pilonidal sinus disease with the use of a diode laser: a prospective large series of patients. Colorectal Dis. 2018;20(8):207-14.

Dessily M, Dziubeck M, Chahidi E, Simonelli V. The SiLaC procedure for pilonidal sinus disease: long-term outcomes of a single institution. Tech Coloproctol. 2019;23(12):1133-40.

Romic I, Augustin G, Bogdanic B. Laser treatment of pilonidal disease: a systematic review. Lasers Med Sci. 2022;37(2):723-32.

Kalaiselvan R, Bathla S, Allen W. Minimally invasive techniques in the management of pilonidal disease. Int J Colorectal Dis. 2019;34(4):561-8.

Van Hoof S, De Decker M, Sels T. Minimally invasive laser-assisted therapy for pilonidal sinus disease: a multicentre study. Int J Colorectal . Dis. 2023;38(1):33.

Sahsamanis G, Samaras S, Mitsopoulos G. Semi-closed surgical technique for treatment of pilonidal sinus disease. Ann Med Surg. 2017;15:47-51.

Pronk AA, Smakman N, Furnee EJB. Short-term outcomes of radical excision versus phenolisation of the sinus tract in primary pilonidal sinus disease. Tech Coloproctol. 2019;23(7):665-73.

Li Z, Jin L, Gong T. An effective and considerable treatment of pilonidal sinus disease by laser ablation. Lasers Med Sci. 2023;38(1):82.

Harju J, Söderlund F, Yrjönen A. Pilonidal disease treatment by radial laser surgery (FiLaC): the first Finnish experience. Scand J Surg. 2021;110(4):520-3.

Bonito F, Cerejeira D, Goulão J. Safety and efficacy of radial diode laser in the treatment of pilonidal sinus disease. Dermatol Surg. 2021;47(9):1224-8.

Yardimci VH. Outcomes of two treatments for pilonidal sinus disease: Karydakis flap and sinus tract ablation using a 1470 nm diode laser. Lasers Surg Med. 2020;52(9):848-54.

Emral AC, Gülen M, Ege B. Comparison of laser ablation and crystallized phenol treatment in pilonidal sinus disease. Front Surg. 2025;11:1494382.

Emral AC, Yazici SE. Evaluation of laser ablation for recurrent pilonidal sinus disease: treatment success, recurrence and outcomes. Lasers Med Sci. 2025;40:281.

Qin J, Xu X, Li Z, et al. Efficacy and safety of laser ablation for recurrent pilonidal sinus disease: a systematic review and meta-analysis. Int J Colorectal Dis. 2025;40(1):47.

Sluckin TC, Hazen SJA, Smeenk RM, Schouten R. Sinus laser-assisted closure (SiLaC) for pilonidal sinus disease: results of a multicentre cohort study. Tech Coloproctol. 2022;26(2):135-41.