{ "slug": "pilonidal-cyst-laser-treatment", "question": "Does laser treatment work for pilonidal cysts?", "shortTitle": "Laser Treatment for Pilonidal Cysts", "clinicalQuestion": "In patients with pilonidal sinus disease, does laser ablation of the sinus tract (e.g., sinus laser treatment/SiLaT), with or without adjunctive laser hair removal, improve healing time, recurrence rate, and complication rates compared with conventional surgical excision?", "pico": { "population": "Adults and adolescents with pilonidal cyst/sinus disease (acute or chronic, including recurrent cases)", "intervention": "Laser ablation of the pilonidal sinus tract (e.g., sinus laser treatment, SiLaT) and/or adjunctive laser hair removal", "comparator": "Conventional surgical excision (open or closed techniques) or no laser treatment", "outcomes": [ "Time to complete wound healing", "Recurrence rate at 12 months", "Postoperative pain scores", "Wound infection or complication rate", "Return to work/normal activity time", "Patient satisfaction/quality of life scores" ] }, "category": "anorectal", "relatedConditions": [ "pilonidal-sinus", "pilonidal-cyst" ], "relatedTreatments": [], "relatedEvidence": [], "bottomLine": { "verdict": "The evidence on laser treatment for pilonidal cysts is mixed, and one well-conducted trial found it was linked to more cysts coming back, not fewer.", "detail": "Four moderate-quality randomised trials have tested laser treatments for pilonidal sinus disease, and they do not agree with each other. One trial of 302 people found that adding laser hair removal to standard hygiene care lowered the one-year recurrence rate. Another trial of 60 people found the opposite: adding laser hair removal to flap surgery was linked to more cysts returning, not fewer. A third trial found no difference when laser ablation was added to curettage. Because well-conducted trials point in different directions, overall certainty is only moderate, and the harm finding means caution is warranted.", "studyIds": [ "pmid:41365098", "pmid:40100423", "pmid:37938854", "pmid:25932257" ] }, "strength": { "level": "moderate", "why": "4 well-conducted randomised trials address this question directly. The studies disagree with one another, so the overall certainty is lower than any single one of them.", "override": null }, "direction": { "level": "harm-signal", "why": "A well-conducted study in people reported harm.", "override": null }, "counts": { "recordsRetrieved": 192, "recordsScreened": 192, "included": 149, "rcts": 11, "systematicReviews": 12, "observational": 64, "participants": 28720, "yearFrom": 1989, "yearTo": 2026, "registeredTrialsWithoutResults": 0 }, "excluded": [], "outcomes": [ { "name": "Time to complete wound healing", "status": "insufficient", "note": "Evidence on wound healing time is mixed and mostly comes from non-randomised studies. Some found faster healing with laser than with older surgical techniques (for example, 6.5 vs 14.5 weeks comparing laser with wide excision in one study, and faster healing with laser than with crystallised phenol in another), but a systematic review of laser techniques found a lower overall primary healing rate with laser than with traditional surgery. Only one of these studies was a randomised trial, and it measured operative time and return to activity rather than total wound-healing time, so the question of whether laser speeds healing is not settled.", "studyIds": [ "pmid:38530042", "pmid:39834506", "pmid:33966964", "pmid:32064640", "pmid:37438655" ] }, { "name": "Recurrence rate at 12 months", "status": "possible-harm", "note": "This is a key outcome, and the randomised trials that measured it disagree. One trial of 302 people found that adding laser hair removal to standard hygiene care lowered recurrence at 1 year; a secondary analysis of that same trial, restricted to the 200 patients with complete 1-year follow-up, found this benefit held only for privately insured patients, not publicly insured ones. A separate, smaller trial of 60 people found that adding laser hair removal to flap surgery was linked to more cysts returning (20% vs 4%). A third trial of 80 people found that adding laser ablation to curettage made no difference to recurrence after 6 months. Because these trials disagree, and one found harm, this outcome cannot be called a clear benefit.", "studyIds": [ "pmid:37938854", "pmid:25932257", "pmid:41365098", "pmid:40100423" ] }, { "name": "Postoperative pain scores", "status": "possible-improvement", "note": "Several studies, including some randomised trials, found less pain in the days after laser treatment compared with traditional surgery such as lay-open technique or flap surgery. Most of this evidence comes from small or non-randomised studies.", "studyIds": [ "pmid:40108765", "pmid:39699772", "pmid:34042233", "pmid:37440707" ] }, { "name": "Wound infection or complication rate", "status": "insufficient", "note": "Studies disagree with each other. Some found fewer complications with laser treatment than with surgery or phenol, while others found more infections and complications with laser. There isn't enough consistent evidence to say which is safer.", "studyIds": [ "pmid:42128975", "pmid:38291247", "pmid:37438655", "pmid:41146596", "pmid:39578271", "pmid:35678224" ] }, { "name": "Return to work/normal activity time", "status": "possible-improvement", "note": "Multiple studies, mostly retrospective, found people returned to work or normal activity sooner after laser treatment than after traditional surgery. None of these were large, well-conducted randomised trials.", "studyIds": [ "pmid:39995244", "pmid:39699772", "pmid:32064640", "pmid:34042233", "pmid:42237035" ] }, { "name": "Patient satisfaction/quality of life scores", "status": "possible-improvement", "note": "Several studies reported higher satisfaction scores with laser treatment compared with other treatments, but satisfaction was usually measured in the short term and without randomisation in most studies.", "studyIds": [ "pmid:42237035", "pmid:37356014", "pmid:34042233", "pmid:33966964" ] } ], "benefits": [ { "text": "In several studies comparing laser treatment with other treatments, people reported less pain and a faster return to work in the days after the procedure.", "studyIds": [ "pmid:40108765", "pmid:39699772", "pmid:37440707", "pmid:34042233", "pmid:32064640" ] }, { "text": "In several studies comparing laser treatment with traditional surgery, laser treatment was linked to shorter hospital stays, faster wound healing, and in some cases shorter operating time, though no single study measured all of these at once. One study found wound healing was significantly faster with laser (mean 6.5 weeks) than with wide excision (mean 14.5 weeks), with no significant difference in recurrence. Another found hospital stay was significantly shorter with laser pilonidotomy (mean 8 hours) than with other surgical techniques. A third found laser had a shorter operative time and hospital stay, and less pain, than Limberg flap surgery, with similar healing and recurrence rates. A fourth found faster wound healing and less post-operative pain with laser than with crystallized phenol treatment. These were non-randomised comparisons, so the findings are not conclusive.", "studyIds": [ "pmid:38530042", "pmid:39995244", "pmid:33966964", "pmid:39834506" ] } ], "limitations": [ { "text": "Most of the studies are small, retrospective reviews of patients who already received laser treatment, with no comparison group. This means differences in outcomes could be due to who was chosen for treatment, not the laser itself.", "studyIds": [ "pmid:42852833", "pmid:42266118", "pmid:42126480", "pmid:38849230", "pmid:36888964" ] }, { "text": "Studies described as 'laser treatment' are not all testing the same thing: some use a laser to seal the sinus tract itself, others use laser only to remove hair from the area afterward, and some combine the two with surgery or other procedures. For example, one study of laser hair removal added after surgery could not separate the laser's own effect from the effect of which surgical technique was used, and another pooled pilonidal sinus disease together with unrelated skin conditions like hirsutism without reporting a result specific to pilonidal disease. This makes it hard to know, from many of these studies, which part of the treatment was responsible for the outcome.", "studyIds": [ "pmid:42089833", "pmid:40464115", "pmid:37256592" ] }, { "text": "The four best-conducted randomised trials disagree with each other on whether laser treatment helps, makes no difference, or causes more cysts to return, which lowers confidence in any single conclusion.", "studyIds": [ "pmid:41365098", "pmid:40100423", "pmid:37938854", "pmid:25932257" ] }, { "text": "Many studies followed patients for only a few months to a year. Pilonidal cysts can come back years later, so short follow-up may miss recurrences that happen after the study ended.", "studyIds": [ "pmid:42266118", "pmid:42126480", "pmid:41834241" ] } ], "risks": [ { "text": "One well-conducted trial found that adding laser hair removal to flap surgery was linked to more cysts coming back within a year (20%) than flap surgery alone (4%).", "studyIds": [ "pmid:25932257" ], "severity": "serious" }, { "text": "A large study found that laser ablation of the sinus tract alone had a significantly higher rate of the cyst coming back than open flap surgery.", "studyIds": [ "pmid:39953215" ], "severity": "serious" }, { "text": "Some studies reported more pain, more infections, or more complications with laser treatment compared with other options like crystallized phenol or holmium laser.", "studyIds": [ "pmid:41146596", "pmid:39578271" ], "severity": "minor" }, { "text": "Reported complications after laser treatment have generally been minor and infrequent. One study found delayed wound healing in 20.5% of patients, and another found a 10% recurrence rate, with some of those patients needing a second laser session to achieve healing. Other studies describe overall complication rates as low, though the specific types of complications (such as infection) were not always detailed.", "studyIds": [ "pmid:42266118", "pmid:41316137", "pmid:38704463" ], "severity": "minor" } ], "whyPeopleTryIt": [ { "text": "It sounds less invasive than cutting out the cyst, which appeals to people afraid of surgery or scarring." }, { "text": "It's often advertised as a quick, in-office procedure with little downtime." }, { "text": "After one or more surgeries that didn't fix the problem, people look for something different to try." }, { "text": "The idea of removing hair from the area to stop it causing problems again makes intuitive sense." } ], "keyStudies": [ "pmid:37938854", "pmid:25932257", "pmid:41365098", "pmid:40100423", "pmid:39036233", "pmid:39953215", "pmid:29185064" ], "studies": [ { "id": "pmid:42852833", "pmid": "42852833", "doi": "10.1177/14574969261488782", "nctId": null, "pmcid": null, "title": "Outpatient laser treatment of pilonidal sinus disease: A retrospective study of short-term outcomes", "firstAuthor": "Sirkka", "multipleAuthors": true, "journal": "Scand J Surg", "year": 2026, "design": "retrospective", "n": 80, "nField": "reported", "population": "patients with pilonidal sinus disease treated as outpatients", "intervention": "laser treatment (Sinus Laser-assisted Closure) under local anesthesia in an outpatient clinic", "comparator": "none (no comparison group; outcomes assessed within this single treated group)", "primaryOutcome": "rates of persistent disease and recurrence after treatment", "result": "10% had persistent disease and 11% had recurrence, with short sick leave and low complication rates", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a small retrospective study with no comparison group, so it can't show whether laser works better than other treatments.", "directness": "direct", "limitations": "Retrospective single-center design, no control group, and reliance on patients to self-report recurring symptoms.", "followUp": "14.4 (SD = 8.3) months", "plainFinding": "Mostly healed, some recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42852833/", "sourceText": "BACKGROUND AND AIMS: Sinus Laser-assisted Closure has been shown to be a safe and effective treatment option for pilonidal sinus disease. The aim of this study was to evaluate the short-term outcomes of outpatient laser pilonidal sinus surgery and to determine whether treatment in an outpatient clinic setting influences postoperative recovery and recurrence rates. METHODS: A single-center retrospective analysis was conducted including all consecutive patients with pilonidal sinus disease who underwent Sinus Laser-assisted Closure treatment in an outpatient setting under local anesthesia between 2021 and 2024. Selected patients were scheduled for follow-up, and all patients were instructed to contact the department in case of continuous or recurrent complaints for a clinical assessment of persistent disease or recurrence at the outpatient clinic. Persistent or residual disease within 2 months after the procedure was classified as residual disease, whereas disease detected after 2 months was classified as recurrence. Final rates of persistent disease and recurrence were assessed retrospectively from electronic medical records in December 2024. Patient-related data were collected from medical records, and statistical analyses were performed using IBM SPSS Statistics, version 29. RESULTS: Between 01 January 2021 and 31 December 2024, 80 patients were treated with outpatient Sinus Laser-assisted Closure-56 (70%) men and 24 (30%) women. The mean age was 34.9 (SD = 10.7) years. The mean follow-up period was 14.4 (SD = 8.3) months, with a minimum follow-up of 2 months. Persistent disease was reported by eight (10%) patients. Disease recurrence occurred in nine patients (11%). The mean duration of sick leave was 3.0 (SD = 4.7) days. Postoperative infections were observed in six patients (8%), four (5%) of whom required postoperative wound care. No other complications were reported. CONCLUSIONS: Outpatient Sinus Laser-assisted Closure under local anesthesia is an effective and feasible alternative to operating room-based surgery for selected patients with pilonidal sinus disease, with promising healing outcomes and a favorable recovery and complication profile.", "provenance": [ { "field": "n", "quote": "80 patients were treated with outpatient Sinus Laser-assisted Closure" }, { "field": "population", "quote": "all consecutive patients with pilonidal sinus disease who underwent Sinus Laser-assisted Closure treatment in an outpatient setting under local anesthesia" }, { "field": "intervention", "quote": "Sinus Laser-assisted Closure treatment in an outpatient setting under local anesthesia" }, { "field": "comparator", "quote": "The aim of this study was to evaluate the short-term outcomes of outpatient laser pilonidal sinus surgery" }, { "field": "primaryOutcome", "quote": "Persistent disease was reported by eight (10%) patients. Disease recurrence occurred in nine patients (11%)." }, { "field": "result", "quote": "Persistent disease was reported by eight (10%) patients. Disease recurrence occurred in nine patients (11%). The mean duration of sick leave was 3.0 (SD = 4.7) days." }, { "field": "followUp", "quote": "The mean follow-up period was 14.4 (SD = 8.3) months" } ] }, { "id": "pmid:42830906", "pmid": "42830906", "doi": "10.7759/cureus.115748", "nctId": null, "pmcid": "PMC13634159", "title": "Sinus Laser-Assisted Closure Under Tumescent Local Anesthesia for Pilonidal Disease: A Pilot Study", "firstAuthor": "Pomper", "multipleAuthors": true, "journal": "Cureus", "year": 2026, "design": "case-series", "n": 22, "nField": "reported", "population": "patients with pilonidal sinus disease", "intervention": "laser closure of pilonidal sinus (SiLaC) under tumescent local anesthesia", "comparator": "none (no control group)", "primaryOutcome": "feasibility, pain levels, complications, and recurrence after treatment", "result": "procedure was feasible and well tolerated, with low pain scores, few minor complications, and no recurrences at 90 days", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This was a small pilot study with only 22 patients, no comparison group, and short follow-up, so it cannot show whether laser treatment works better than other options.", "directness": "direct", "limitations": "Given the small sample size, absence of a control group, and limited follow-up, larger prospective comparative studies with longer follow-up are needed to validate these findings", "followUp": "90 days", "plainFinding": "Feasible, low pain, no recurrence", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42830906/", "sourceText": "OBJECTIVES: Sinus laser-assisted closure (SiLaC) is a minimally invasive option for management of pilonidal sinus disease (PSD). Tumescent local anesthesia (TLA) may further facilitate outpatient treatment; however, its use in this setting has not been adequately studied. This pilot study aimed to assess the feasibility of SiLaC performed under TLA. MATERIALS AND METHODS: Between September 2025 and January 2026, 22 consecutive patients with PSD underwent SiLaC under TLA. Demographic characteristics, operative time, total volume of tumescent solution, and calculated lidocaine dose were recorded. Pain was assessed preoperatively, intraoperatively, and on postoperative days 1, 2, 3, and 7 using the Visual Analog Scale (VAS; 0-10). Postoperative complications and outpatient follow-up visits were documented, and early recurrence was assessed at 90 days within a predefined follow-up window of 90 ± 7 days. RESULTS: The median age was 23 years (range, 18-62 years), and 19 of 22 patients were male. Median operative time was 30 minutes (range, 25-45 minutes), and median tumescent volume was 160 mL (range, 80-280 mL). Median VAS scores were 1 preoperatively (range, 1-2), 2 intraoperatively (range, 1-3), 3 on postoperative day 1 (range, 1-6), 2.5 on day 2 (range, 1-5), 2 on day 3 (range, 1-7), and 1 on day 7 (range, 1-2). Three minor postoperative events occurred: two cases of localized painful swelling and one case of minor bleeding. No anesthesia-related or major complications were observed. All 22 patients completed the 90-day follow-up; no patients were lost to follow-up, and no recurrences, wound healing disorders, or delayed complications were observed in the full evaluable cohort (0/22). CONCLUSION: SiLaC performed under TLA appears feasible, well tolerated, and safe for appropriately selected patients in an outpatient setting. Given the small sample size, absence of a control group, and limited follow-up, larger prospective comparative studies with longer follow-up are needed to validate these findings and to determine whether TLA offers advantages over conventional local infiltration anesthesia, particularly in more extensive disease.", "provenance": [ { "field": "population", "quote": "22 consecutive patients with PSD underwent SiLaC under TLA" }, { "field": "intervention", "quote": "Sinus laser-assisted closure (SiLaC) is a minimally invasive option for management of pilonidal sinus disease (PSD)" }, { "field": "comparator", "quote": "absence of a control group" }, { "field": "primaryOutcome", "quote": "Pain was assessed preoperatively, intraoperatively, and on postoperative days 1, 2, 3, and 7 using the Visual Analog Scale (VAS; 0-10)." }, { "field": "result", "quote": "no recurrences, wound healing disorders, or delayed complications were observed in the full evaluable cohort (0/22)" }, { "field": "n", "quote": "22 consecutive patients with PSD underwent SiLaC under TLA" }, { "field": "followUp", "quote": "All 22 patients completed the 90-day follow-up" } ] }, { "id": "pmid:42657982", "pmid": "42657982", "doi": "10.4103/jmas.jmas_382_26", "nctId": null, "pmcid": null, "title": "Laser ablation for pilonidal sinus disease", "firstAuthor": "Jhawar", "multipleAuthors": true, "journal": "J Minim Access Surg", "year": 2026, "design": "case-series", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus disease", "intervention": "laser ablation of the sinus tract using a 1470-nm diode laser (14-step technique)", "comparator": "none reported", "primaryOutcome": "overall safety, recovery, pain and recurrence after the procedure", "result": "described as safe, minimally invasive, quick recovery, little pain and acceptable recurrence", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a technique description without patient numbers, measured outcomes, or a comparison group, so it can't show whether laser treatment actually works better than other options.", "directness": "direct", "limitations": "No patient numbers, no quantitative outcome data, and no control group are reported; claims of safety and effectiveness are not backed by measured results.", "followUp": "", "plainFinding": "Claims safe, quick recovery, low recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42657982/", "sourceText": "We describe a standardised 14-step technique for pilonidal sinus tract ablation using a radial 1470-nm diode laser. The protocol incorporates systematic tract identification, methylene blue staining, pit excision and sequential curettage, followed by a dual curettage-dual ablation cycle with ice-cold saline cooling. Laser ablation is a safe, minimally invasive, day-case procedure offering rapid recovery, minimal post-operative pain and acceptable recurrence rates.", "provenance": [ { "field": "intervention", "quote": "a standardised 14-step technique for pilonidal sinus tract ablation using a radial 1470-nm diode laser" }, { "field": "comparator", "quote": "Laser ablation is a safe, minimally invasive, day-case procedure" }, { "field": "primaryOutcome", "quote": "Laser ablation is a safe, minimally invasive, day-case procedure offering rapid recovery, minimal post-operative pain and acceptable recurrence rates." }, { "field": "result", "quote": "Laser ablation is a safe, minimally invasive, day-case procedure offering rapid recovery, minimal post-operative pain and acceptable recurrence rates." }, { "field": "population", "quote": "pilonidal sinus tract ablation" } ] }, { "id": "pmid:42560577", "pmid": "42560577", "doi": "10.1007/s00383-026-06553-w", "nctId": null, "pmcid": null, "title": "Laser-assisted endoscopic treatment of pilonidal sinus disease in children: a first pediatric series", "firstAuthor": "Türker Çolak", "multipleAuthors": true, "journal": "Pediatr Surg Int", "year": 2026, "design": "retrospective", "n": 45, "nField": "reported", "population": "children under 18 years old with pilonidal sinus disease", "intervention": "laser-assisted endoscopic treatment of the pilonidal sinus (LEPSIT)", "comparator": "none - all patients received the same laser procedure, no control group", "primaryOutcome": "successful healing of the pilonidal sinus after treatment", "result": "91.1% were cured after one laser procedure, and all patients were eventually cured after a second procedure if needed", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective case series without a comparison group, so it cannot show whether laser treatment works better than other options.", "directness": "direct", "limitations": "Retrospective study design with no control or comparator group, limiting ability to judge effectiveness relative to other treatments.", "followUp": "32.4 ± 11.3 months", "plainFinding": "High cure rate, low pain.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42560577/", "sourceText": "BACKGROUND: This study aims to describe the technical details of laser-assisted endoscopic pilonidal sinus treatment (LEPSIT), a method used for the first time in pediatric pilonidal sinus disease (PSD), and to report early-stage clinical outcomes in a pediatric cohort. METHODS: Clinical data of children under 18 years of age who underwent LEPSIT for PSD between November 2021 and July 2023 were retrospectively analyzed. RESULTS: Of the 45 patients included, 19 (42.2%) were female, and 26 (57.8%) were male; the mean age at surgery was 15.2 ± 3.1 years, and the mean body mass index was 25.1 ± 3.2. Of the 45 patients, 35 presented with an acute pilonidal abscess at initial evaluation and had undergone abscess drainage prior to LEPSIT. Six patients had been previously operated on for pilonidal sinus disease at an external center prior to LEPSIT. Mean procedure duration was 30 ± 7.2 min. The mean visual analog scale (VAS) score at 6 h was 1.8, 24 h was 1,1 and the mean analgesic use was 1 ± 0.3 days. Successful treatment was achieved in 41 patients (91.1%) after a single procedure; 4 patients (8.9%) had recurrence, all of whom achieved cure after a second LEPSIT. Improvement was ultimately achieved in all 45 patients. Mean follow-up was 32.4 ± 11.3 months. CONCLUSION: LEPSIT is an easy-to-administer, minimally painful (mean VAS score: 1.1), and minimally invasive treatment that shortens hospital stay and enables rapid return to daily activities. It is also a safe and well-tolerated option for recurrent PSD.", "provenance": [ { "field": "n", "quote": "Of the 45 patients included" }, { "field": "population", "quote": "Clinical data of children under 18 years of age who underwent LEPSIT for PSD" }, { "field": "intervention", "quote": "laser-assisted endoscopic pilonidal sinus treatment (LEPSIT)" }, { "field": "comparator", "quote": "Clinical data of children under 18 years of age who underwent LEPSIT for PSD between November 2021 and July 2023 were retrospectively analyzed." }, { "field": "primaryOutcome", "quote": "Successful treatment was achieved in 41 patients (91.1%) after a single procedure" }, { "field": "result", "quote": "Successful treatment was achieved in 41 patients (91.1%) after a single procedure; 4 patients (8.9%) had recurrence, all of whom achieved cure after a second LEPSIT. Improvement was ultimately achieved in all 45 patients." }, { "field": "followUp", "quote": "Mean follow-up was 32.4 ± 11.3 months." } ] }, { "id": "pmid:42457154", "pmid": "42457154", "doi": "10.1055/a-2913-8222", "nctId": null, "pmcid": null, "title": "The Minimally Invasive Pilonidal Protocol: Low Short-Term Recurrence after Completion in a Single-Center Retrospective Cohort Study", "firstAuthor": "Murtadi", "multipleAuthors": true, "journal": "Eur J Pediatr Surg", "year": 2026, "design": "retrospective", "n": 297, "nField": "reported", "population": "patients with pilonidal cyst disease who completed a minimally invasive care protocol", "intervention": "Minimally Invasive Pilonidal Protocol (MIPP) including pit-picking procedures and laser hair removal/epilation sessions", "comparator": "no comparison group - single treatment group only", "primaryOutcome": "recurrence of pilonidal disease after completing the protocol", "result": "4.0% of patients had a confirmed recurrence after finishing treatment, most were mild and resolved again with the same minimally invasive care", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective, single-center study with no comparison group and more than half of the original patients were lost to follow-up or still in treatment, so the low recurrence rate may not reflect everyone treated.", "directness": "direct", "limitations": "Retrospective design, no control group, 353 of 884 patients lost to follow-up and 226 still receiving care were excluded, and only 25.7% of contacted graduates who did not return responded to the follow-up survey.", "followUp": "ranged from 4 to 55 months", "plainFinding": "Low recurrence after laser-based protocol.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42457154/", "sourceText": "BACKGROUND: The optimal treatment of pilonidal disease remains uncertain, with recurrence rates up to 30% after resection or sinusectomy. This retrospective single-center cohort study evaluates the recurrence rate after graduation from our Pilonidal Care Clinic's (PCC) Minimally Invasive Pilonidal Protocol (MIPP). METHODS: We conducted a retrospective review of a single center's prospectively collected demographic and treatment data for patients with pilonidal disease who completed the MIPP between January 2021 and December 2024. Follow-up appointments were scheduled every 6 to 8 weeks, continuing until disease resolution and completion of laser ablation sessions. The analysis focused on patients who graduated. Patients still receiving care at study completion and those lost to follow-up were excluded. Recurrence was defined as any PCC visit after graduation with pilonidal disease on examination. Graduated patients who had not returned to the PCC were contacted via text message and queried about new symptoms since graduation. RESULTS: Of the initial 884 patients, 8 patients presented for a second opinion only, 353 were lost to follow-up, and 226 were still receiving care, leaving the study group of 297 patients who completed the protocol and graduated. They graduated after an average of 6.4 PCC visits, two pit-picking procedures, and 5.3 laser epilations. The average disease duration before treatment was 11.4 months. The mean treatment duration was 12.3 months (standard deviation: 8), with a median of 10 months (interquartile range: 6-17). The follow-up period for these patients ranged from 4 to 55 months. Of the 297 graduates, 17 patients (5.7%) returned to the PCC with recurrence concerns; however, only 12 (4.0%) showed physical evidence of recurrence: 8 of them (66.7%) had new pits and 4 (33.3%) had both pits and a nidus. The other 5 showed no signs of pilonidal disease on examination. Recurrence occurred on average 16.3 months after graduating, and 9 of 12 patients with a recurrence were successfully regraduated; 3 were lost to follow-up. Among the 280 patients who did not revisit the clinic, 72 (25.7%) replied to the text survey: 68 (94.4%) of respondents remained disease-free, whereas 4 (5.6%) reported recurrence, 2 of whom sought medical care. CONCLUSION: Completion of the MIPP at this center is associated with a 4.0% recurrence rate within 16 months, with most recurrences mild and again resolved with minimally invasive care.", "provenance": [ { "field": "population", "quote": "patients with pilonidal disease who completed the MIPP between January 2021 and December 2024" }, { "field": "intervention", "quote": "graduation from our Pilonidal Care Clinic's (PCC) Minimally Invasive Pilonidal Protocol (MIPP)" }, { "field": "intervention", "quote": "two pit-picking procedures, and 5.3 laser epilations" }, { "field": "comparator", "quote": "This retrospective single-center cohort study evaluates the recurrence rate after graduation" }, { "field": "primaryOutcome", "quote": "Recurrence was defined as any PCC visit after graduation with pilonidal disease on examination." }, { "field": "result", "quote": "Of the 297 graduates, 17 patients (5.7%) returned to the PCC with recurrence concerns; however, only 12 (4.0%) showed physical evidence of recurrence" }, { "field": "result", "quote": "Completion of the MIPP at this center is associated with a 4.0% recurrence rate within 16 months, with most recurrences mild and again resolved with minimally invasive care." }, { "field": "n", "quote": "leaving the study group of 297 patients who completed the protocol and graduated" }, { "field": "followUp", "quote": "The follow-up period for these patients ranged from 4 to 55 months." } ] }, { "id": "pmid:42266118", "pmid": "42266118", "doi": "10.3393/ac.2025.00927.0132", "nctId": null, "pmcid": "PMC13254771", "title": "Sinus laser-assisted closure for pilonidal sinus disease: a prospective single-center study", "firstAuthor": "Esposito", "multipleAuthors": true, "journal": "Ann Coloproctol", "year": 2026, "design": "case-series", "n": 218, "nField": "reported", "population": "young adults with pilonidal sinus disease", "intervention": "laser treatment of the sinus (SiLaC)", "comparator": "none (single-arm study, no comparison group)", "primaryOutcome": "healing rate, recurrence, complications, pain and satisfaction after laser treatment", "result": "Most patients healed by 45 days (98.1%), 8.7% had recurrence, 15.1% had complications (mostly minor), and satisfaction was high", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a single-group study without a comparison treatment, so it cannot show whether laser worked better than other options.", "directness": "direct", "limitations": "Retrospective analysis of prospectively collected data, no control group, short median follow-up of 11 months", "followUp": "median follow-up of 11 months (range, 3-25 months)", "plainFinding": "High healing, low recurrence, no comparison group.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42266118/", "sourceText": "PURPOSE: Pilonidal sinus disease (PSD) is a chronic condition that primarily affects young adults. Sinus laser-assisted closure (SiLaC) has recently emerged as a minimally invasive alternative to conventional surgery, offering potential benefits in postoperative recovery and recurrence rates. This study evaluates the clinical outcomes, safety, and patient satisfaction associated with SiLaC. METHODS: We conducted a retrospective analysis of prospectively collected data from 218 consecutive patients who underwent SiLaC for PSD between February 2023 and December 2024. Demographic characteristics, intraoperative parameters, postoperative complications, healing rates, and recurrence rates were examined. Pain and patient satisfaction were assessed using a standardized questionnaire. RESULTS: The study cohort included 142 male patients (65.1%), with a mean age of 25.3±8.1 years. The mean operative time was 13.4±4.4 minutes, and all patients were discharged the same day. The overall complication rate was 15.1%, with most complications being minor abscesses (84.8% managed conservatively). Healing rates at 15, 30, and 45 days were 13.8%, 80.2%, and 98.1%, respectively, with a mean healing time of 26.1±9.8 days. Recurrence was observed in 8.7% of patients after a median follow-up of 11 months (range, 3-25 months), decreasing to 6.5% following a second SiLaC procedure. The mean pain score on postoperative day 1 was 2.8±2.4, and patient satisfaction at 30 days was 9.2 out of 10. CONCLUSION: SiLaC is a safe, effective, and well-tolerated minimally invasive treatment for PSD, associated with favorable short-term outcomes, rapid recovery, and low recurrence rates. Further research is needed to optimize treatment protocols and assess long-term outcomes.", "provenance": [ { "field": "population", "quote": "218 consecutive patients who underwent SiLaC for PSD" }, { "field": "intervention", "quote": "Sinus laser-assisted closure (SiLaC)" }, { "field": "comparator", "quote": "retrospective analysis of prospectively collected data from 218 consecutive patients who underwent SiLaC for PSD" }, { "field": "primaryOutcome", "quote": "Demographic characteristics, intraoperative parameters, postoperative complications, healing rates, and recurrence rates were examined." }, { "field": "result", "quote": "Healing rates at 15, 30, and 45 days were 13.8%, 80.2%, and 98.1%, respectively, with a mean healing time of 26.1±9.8 days. Recurrence was observed in 8.7% of patients after a median follow-up of 11 months" }, { "field": "n", "quote": "218 consecutive patients who underwent SiLaC for PSD" } ] }, { "id": "pmid:42237035", "pmid": "42237035", "doi": "10.1007/s10151-026-03345-1", "nctId": null, "pmcid": "PMC13447342", "title": "Early postoperative outcomes of sinus laser closure versus crystallized phenol treatment for pilonidal sinus disease: a retrospective comparative study", "firstAuthor": "Yildirak", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2026, "design": "retrospective", "n": 230, "nField": "reported", "population": "Patients with pilonidal sinus disease treated at a tertiary center", "intervention": "Laser closure of the sinus tract (SiLaC)", "comparator": "Crystallized phenol treatment (CPT)", "primaryOutcome": "Patient satisfaction, quality of life, symptom severity, pain, and return to work at 1 week and 1 month", "result": "Laser treatment gave less pain, fewer symptoms, and better quality of life at 1 week, with most differences no longer significant by 1 month", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective, non-randomized comparison, so differences between groups could be due to factors other than the treatment itself.", "directness": "direct", "limitations": "Retrospective design; not randomized; short follow-up of only 1 month; authors call for randomized trials to confirm findings.", "followUp": "1 month", "plainFinding": "Less pain and faster early recovery with laser.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42237035/", "sourceText": "BACKGROUND: Pilonidal sinus disease (PSD), which predominantly affects young adults, has increasingly been managed with minimally invasive techniques aimed at reducing postoperative pain, accelerating recovery, and minimizing work absenteeism. This study aimed to compare the early term outcomes of patients treated with crystallized phenol treatment (CPT) or sinus laser closure (SiLaC) for PSD. METHODS: We retrospectively analyzed a prospectively maintained cohort at a tertiary center between January 2023 and August 2024. Patients with PSD undergoing SiLaC or CPT with scheduled 1-week and 1-month follow-up assessments were included. The primary outcomes were patient satisfaction, health-related quality of life (SF-36), symptom severity (itching, burning, purulent discharge), pain intensity (Visual Analogue Scale), and time to return to work, all assessed at 1 week and 1 month postoperatively. Secondary outcomes included pit orifice closure rates and perioperative complications. RESULTS: A total of 230 patients were analyzed (SiLaC n = 93; CPT n = 137), with comparable baseline characteristics. At 1 week, itching (1 [1-1] versus 1 [1-2], p < 0.001), burning (1 [1-1] versus 1 [1-2], p = 0.001), and purulent discharge (1 [1-1] versus 1 [1-3], p < 0.001) were less frequent in the SiLaC group. Pain scores were also lower in the SiLaC group (VAS: 0 [0-1] versus 0 [0-5], p = 0.034). SF-36 scores were significantly higher in the SiLaC group for physical functioning (100 [90-100] versus 95 [85-100], p < 0.001), physical role limitation (100 [100-100] versus 100 [75-100], p = 0.005), social functioning (100 [87.5-100] versus 87.5 [62.5-100], p < 0.001), and pain (100 [67.5-100] versus 90 [67.5-100], p = 0.008). Return to daily activities was shorter in the SiLaC group (0 [0-0] versus 0 [0-1] days, p < 0.001). At 1 month, most outcomes were comparable between groups, although purulent discharge remained higher in the CPT group (1 [1-2] versus 1 [1-1], p = 0.045). Complication rates were low and similar between groups (9.6% versus 12.4%, p = 0.489). CONCLUSIONS: The SiLaC method was associated with more favorable quality of life (QoL) outcomes compared with CPT during the first postoperative week. Subgroup analyses suggested that SiLaC may offer advantages in certain clinical scenarios. Further multicenter randomized controlled trials are warranted to better clarify and validate these findings.", "provenance": [ { "field": "n", "quote": "A total of 230 patients were analyzed (SiLaC n = 93; CPT n = 137)" }, { "field": "population", "quote": "Patients with PSD undergoing SiLaC or CPT with scheduled 1-week and 1-month follow-up assessments were included." }, { "field": "intervention", "quote": "sinus laser closure (SiLaC)" }, { "field": "comparator", "quote": "crystallized phenol treatment (CPT)" }, { "field": "primaryOutcome", "quote": "The primary outcomes were patient satisfaction, health-related quality of life (SF-36), symptom severity (itching, burning, purulent discharge), pain intensity (Visual Analogue Scale), and time to return to work, all assessed at 1 week and 1 month postoperatively." }, { "field": "result", "quote": "At 1 week, itching (1 [1-1] versus 1 [1-2], p < 0.001), burning (1 [1-1] versus 1 [1-2], p = 0.001), and purulent discharge (1 [1-1] versus 1 [1-3], p < 0.001) were less frequent in the SiLaC group." }, { "field": "result", "quote": "At 1 month, most outcomes were comparable between groups, although purulent discharge remained higher in the CPT group (1 [1-2] versus 1 [1-1], p = 0.045)." } ] }, { "id": "pmid:42128975", "pmid": "42128975", "doi": "10.1007/s10151-026-03314-8", "nctId": null, "pmcid": "PMC13342393", "title": "Does laser treatment affect outcome in pilonidal sinus disease? Long-term multicenter retrospective analysis of pit-picking alone vs. pit-picking with laser", "firstAuthor": "Arslan", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2026, "design": "retrospective", "n": 306, "nField": "reported", "population": "patients who had pit-picking surgery for pilonidal sinus disease", "intervention": "pit-picking combined with laser treatment", "comparator": "pit-picking surgery alone", "primaryOutcome": "recurrence rate at 5 years", "result": "recurrence rates were similar between groups, but laser group had fewer complications, faster pain relief and quicker return to work", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a retrospective, non-randomized comparison, so differences could be due to other factors rather than the laser itself.", "directness": "direct", "limitations": "Retrospective design, not randomized, higher cost in laser group, authors call for randomized trials", "followUp": "5 years", "plainFinding": "Fewer complications and faster recovery, same recurrence", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42128975/", "sourceText": "OBJECTIVES: The optimal management of pilonidal sinus disease (PSD) remains controversial, with multiple treatment approaches available. Pit-picking is a minimally invasive technique, often enhanced with laser treatment (LT), but the long-term benefits of LT remain uncertain. The objective of this study is to compare pit-picking alone versus pit-picking combined with LT. METHODS: This is a multicenter retrospective cohort study including seven centers across Turkey. Patients who underwent pit-picking surgery for PSD between June 2017 and March 2025 were included. Patients receiving adjunctive treatments beyond LT, undergoing excisional procedures, or with incomplete follow-up data were excluded. Pit-picking surgeries performed with or without LT were compared. The primary measure was the recurrence rate at 5 years. Secondary outcomes were postoperative pain, time to complete healing, complications, return to work, and costs. RESULTS: Of 306 patients, 109 (35.6%) underwent pit-picking alone, and 197 (64.4%) received pit-picking with LT. The complication rate was lower in the LT group (6.1% vs. 14.7%, p = 0.012). Patients treated with LT had shorter times to pain-free sitting (median 5 vs. 7 days, p < 0.001) and return to work (3 vs. 6 days, p < 0.001). Complete healing was achieved in 97.4% of patients, with a median time of 14 days. Recurrence rates at 5 years were similar (pit-picking: 13.8%, pit-picking + LT: 12.7%, p = 0.460). Costs were higher for the LT group ($1212 ± 146 vs. $888 ± 148), although complicated pit-picking cases had comparable costs to the LT group ($1198 ± 370, p = 0.004). Risk factors for recurrence included high BMI, family history, advanced Tezel stage, and postoperative complications. CONCLUSIONS: While LT improves early postoperative outcomes, it does not impact long-term recurrence rates. The increased cost of LT should be weighed against its benefits in reducing complications, pain, and recovery time. Further randomized trials are needed to refine patient selection criteria and assess cost-effectiveness. CLINICAL TRIAL REGISTRATION: NCT05569135, Registration date: 05.10.2022.", "provenance": [ { "field": "population", "quote": "Patients who underwent pit-picking surgery for PSD between June 2017 and March 2025 were included." }, { "field": "intervention", "quote": "Pit-picking surgeries performed with or without LT were compared." }, { "field": "comparator", "quote": "Pit-picking surgeries performed with or without LT were compared." }, { "field": "primaryOutcome", "quote": "The primary measure was the recurrence rate at 5 years." }, { "field": "result", "quote": "Recurrence rates at 5 years were similar (pit-picking: 13.8%, pit-picking + LT: 12.7%, p = 0.460)." }, { "field": "result", "quote": "The complication rate was lower in the LT group (6.1% vs. 14.7%, p = 0.012)." }, { "field": "result", "quote": "Patients treated with LT had shorter times to pain-free sitting (median 5 vs. 7 days, p < 0.001) and return to work (3 vs. 6 days, p < 0.001)." }, { "field": "n", "quote": "Of 306 patients, 109 (35.6%) underwent pit-picking alone, and 197 (64.4%) received pit-picking with LT." } ] }, { "id": "pmid:42126480", "pmid": "42126480", "doi": "10.1007/s10151-025-03280-7", "nctId": null, "pmcid": "PMC13342408", "title": "Sinus laser-assisted closure (SiLaC) in pilonidal sinus disease: a multicenter cohort study", "firstAuthor": "de Kort", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2026, "design": "retrospective", "n": 231, "nField": "reported", "population": "adults with primary or recurrent chronic pilonidal sinus disease at the tailbone", "intervention": "laser treatment of the sinus (SiLaC - sinus laser-assisted closure)", "comparator": "no comparison group; primary disease cases compared with recurrent disease cases", "primaryOutcome": "treatment failure (ongoing symptoms or need for further surgery), symptoms, and quality of life at follow-up", "result": "about 18% of primary cases and 20% of recurrent cases had treatment failure, but only 7.8% overall needed surgery other than repeat laser treatment, and quality of life was high", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this was a retrospective study without a comparison group, so it cannot show whether laser treatment works better than other options.", "directness": "direct", "limitations": "Retrospective design, no control group, reliance on patient questionnaires for symptom and quality-of-life data.", "followUp": "33 months", "plainFinding": "Good symptom relief, few needed more surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42126480/", "sourceText": "BACKGROUND: Sinus laser-assisted closure (SiLaC) is gaining popularity as a minimally invasive surgical technique to treat chronic sacrococcygeal pilonidal sinus disease (SPSD). However, long-term outcomes on this technique are rarely reported in the literature. This multicenter study aimed to report the mid-term outcome of a cohort of patients who underwent SiLaC treatment for primary or recurrent SPSD. METHODS: Patients with primary or recurrent SPSD were included in this retrospective cohort study. Data were collected from medical records, and a validated questionnaire was distributed to all patients at follow-up to assess symptoms, quality of life, and the need for additional surgery. RESULTS: A total of 231 patients were included, with a median follow-up of 33 months (IQR 20-44): 128 patients underwent SiLaC for primary SPSD and 103 for recurrent SPSD. Additional interventions were required in 35 patients with primary SPSD (27.3%) and in 30 patients with recurrent SPSD (29.1%). Repeat SiLaC alone, i.e. no other surgical treatment than repeat SiLaC, was performed in 25 patients (19.6%) in the primary group and 22 patients (21.4%) in the recurrent group. Treatment failure, defined as persistent symptoms and/or the need for surgery other than SiLaC, occurred in 23 patients (18.0%) in the primary group and in 21 patients (20.4%) in the recurrent group. However, SPSD-related symptoms were low at follow-up, and quality of life measured by the SF-36 was reported to be even higher than in the general USA population, both in the primary and recurrent group. CONCLUSIONS: SiLaC for primary and recurrent SPSD appeared to be a safe procedure with excellent symptom control and quality of life, with only 7.8% of patients in both groups requiring other surgical treatment than SiLaC.", "provenance": [ { "field": "n", "quote": "A total of 231 patients were included" }, { "field": "population", "quote": "Patients with primary or recurrent SPSD were included in this retrospective cohort study" }, { "field": "intervention", "quote": "Sinus laser-assisted closure (SiLaC) is gaining popularity as a minimally invasive surgical technique to treat chronic sacrococcygeal pilonidal sinus disease" }, { "field": "comparator", "quote": "128 patients underwent SiLaC for primary SPSD and 103 for recurrent SPSD" }, { "field": "primaryOutcome", "quote": "Data were collected from medical records, and a validated questionnaire was distributed to all patients at follow-up to assess symptoms, quality of life, and the need for additional surgery." }, { "field": "result", "quote": "Treatment failure, defined as persistent symptoms and/or the need for surgery other than SiLaC, occurred in 23 patients (18.0%) in the primary group and in 21 patients (20.4%) in the recurrent group." }, { "field": "result", "quote": "only 7.8% of patients in both groups requiring other surgical treatment than SiLaC" }, { "field": "followUp", "quote": "median follow-up of 33 months (IQR 20-44)" } ] }, { "id": "pmid:42089833", "pmid": "42089833", "doi": "10.1111/iwj.70938", "nctId": null, "pmcid": "PMC13148142", "title": "Outcomes of Pilonidal Surgery Performed in the Setting of Standard Adjunct Laser Hair Removal: A Retrospective Cohort Study", "firstAuthor": "Jarrin Lopez", "multipleAuthors": true, "journal": "Int Wound J", "year": 2026, "design": "retrospective", "n": 168, "nField": "reported", "population": "patients ages 14 to 89 who had surgery for pilonidal sinus disease", "intervention": "adjunct laser hair removal used routinely after pilonidal surgery", "comparator": "no non-laser comparison group; compared different surgical techniques (Bascom flap vs pilocystectomy) instead", "primaryOutcome": "repeat procedures, surgical site infection within 30 days, and unplanned clinic visits after surgery", "result": "outcomes differed more by type of surgery used than by patient factors, and the study could not separate out what effect the laser hair removal itself had", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this was a retrospective study with no comparison group that skipped laser hair removal, so it cannot show whether the laser itself helped.", "directness": "indirect", "limitations": "descriptive retrospective design, no control group without laser hair removal, low event counts prevented more detailed statistical modeling", "followUp": "", "plainFinding": "Can't tell if laser helped.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42089833/", "sourceText": "Pilonidal sinus disease (PSD) is associated with substantial morbidity because of wound complications and recurrence after surgery. Adjunct laser hair removal (LHR) has been incorporated into postoperative management in some settings, but real-world outcomes in cohorts treated uniformly with LHR remain incompletely described. This study aimed to characterize postoperative outcomes after PSD surgery in a large integrated healthcare system in which adjunctive LHR was standard practice and to compare outcomes by surgical approach. We performed a retrospective descriptive cohort study of patients aged 14-89 years who underwent operative treatment of PSD with adjunctive LHR at Kaiser Permanente Northern California between 2012 and 2024. Outcomes included repeat procedures, 30-day surgical site infection (SSI), and unplanned clinic visits. Outcomes were summarized as proportions overall and by surgical approach. Exploratory bivariable logistic regression examined associations between sex or body mass index (BMI) and outcomes. Multivariable modeling was not performed because of low event counts and sparse covariate distributions, which resulted in unstable models. Among 168 patients, the overall repeat procedure rate was 16.7%, the 30-day SSI rate was 14.4%, and 39.3% had at least one unplanned clinic visit. Patients treated with Bascom flap closure had fewer repeat procedures (10.4% vs. 20.8%) and fewer unplanned visits (33.8% vs. 43.6%) than those undergoing pilocystectomy, with similar SSI rates (14.9% vs. 14.0%). In exploratory analyses, sex and BMI were not significantly associated with outcomes in either surgical group. In this real-world cohort managed uniformly with adjunctive LHR, postoperative outcomes appeared to vary more by surgical approach than by sex or BMI. These findings are descriptive and do not estimate the independent effect of LHR. Controlled comparative studies are needed to determine the contribution of LHR to PSD outcomes.", "provenance": [ { "field": "population", "quote": "patients aged 14-89 years who underwent operative treatment of PSD with adjunctive LHR" }, { "field": "intervention", "quote": "Adjunct laser hair removal (LHR) has been incorporated into postoperative management" }, { "field": "comparator", "quote": "Outcomes were summarized as proportions overall and by surgical approach" }, { "field": "primaryOutcome", "quote": "Outcomes included repeat procedures, 30-day surgical site infection (SSI), and unplanned clinic visits" }, { "field": "result", "quote": "postoperative outcomes appeared to vary more by surgical approach than by sex or BMI. These findings are descriptive and do not estimate the independent effect of LHR" }, { "field": "n", "quote": "Among 168 patients" } ] }, { "id": "pmid:41999968", "pmid": "41999968", "doi": "10.1016/j.jpedsurg.2026.163145", "nctId": null, "pmcid": null, "title": "Surgical management of pilonidal sinus disease in pediatric population: An updated systematic review and meta-analysis", "firstAuthor": "Saleem", "multipleAuthors": true, "journal": "J Pediatr Surg", "year": 2026, "design": "meta-analysis", "n": 5075, "nField": "reported", "population": "children and teenagers (18 and under) with pilonidal cyst disease", "intervention": "surgical treatments for pilonidal disease, with laser hair removal used alongside some techniques", "comparator": "different surgical techniques compared with each other (open healing, midline closure, off-midline closure, minimally invasive surgery)", "primaryOutcome": "cyst coming back, wound problems, and recovery time", "result": "Adjunctive laser epilation improved outcomes across all techniques.", "resultDirection": "benefit", "quality": "low", "qualityWhy": "It pools many different surgical studies of mixed quality and only briefly mentions laser as an add-on, without giving separate numbers for laser alone.", "directness": "indirect", "limitations": "This is a review in children only, and laser epilation is reported as an add-on to surgery across many different techniques rather than tested on its own.", "followUp": "", "plainFinding": "Laser hair removal added to surgery helped.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41999968/", "sourceText": "BACKGROUND: Pilonidal disease (PD) is a chronic inflammatory condition of the natal cleft that commonly affects pediatric population, leading to high morbidity, frequent recurrences, and impaired quality of life. Despite various surgical approaches, no consensus exists on the optimal technique, and pediatric-specific evidence is limited. OBJECTIVES: To compare recurrence, wound complications, and recovery outcomes across surgical techniques in patients ≤18 years with PD. METHODOLOGY: A systematic search of MEDLINE, Cochrane, and Google Scholar (inception-Dec 2024) identified 59 studies (N = 5075). Data on recurrence, wound complications, healing time, operative time, hospital stay, return to daily activities (ADL), pain scores, and reoperation rates were extracted. Random-effects models were used for pooled estimates. Subgroup analyses and meta-regression explored heterogeneity and impact of follow-up duration. Study quality was assessed using the Newcastle-Ottawa Scale and ROB-2. RESULTS: Open healing showed the highest recurrence (20.1%) and moderate wound complication rates (16.2%), with healing times up to 98 days. Midline primary closure had a recurrence rate of 17.5%, the highest wound complication rate (43.5%), and a reoperation rate of 29.8%. Off-midline closures had the lowest recurrence (10.2%) and moderate complications (19.5%), with healing times as short as 8 days. Minimally invasive techniques (MITs), particularly PEPSiT, demonstrated low recurrence (11.4%), minimal complications (6.5%), short operative times (17-50 min), early return to ADL (1-3 days), and low postoperative pain (VAS 0-2). Adjunctive laser epilation improved outcomes across all techniques. Meta-regression showed longer follow-up was associated with lower recurrence in most groups, except open healing. CONCLUSION: Off-midline closure and minimally invasive strategies, especially when combined with laser epilation, offer superior outcomes in recurrence, complications, and recovery.", "provenance": [ { "field": "n", "quote": "59 studies (N = 5075)" }, { "field": "population", "quote": "patients ≤18 years with PD" }, { "field": "intervention", "quote": "Adjunctive laser epilation improved outcomes across all techniques." }, { "field": "comparator", "quote": "Open healing showed the highest recurrence (20.1%) and moderate wound complication rates (16.2%)" }, { "field": "primaryOutcome", "quote": "To compare recurrence, wound complications, and recovery outcomes across surgical techniques" }, { "field": "result", "quote": "Adjunctive laser epilation improved outcomes across all techniques." } ] }, { "id": "pmid:41964736", "pmid": "41964736", "doi": "10.1007/s00423-026-04026-1", "nctId": null, "pmcid": "PMC13180761", "title": "A systematic review and meta-analysis of sinus laser associated closure (SiLaC) versus endoscopic pilonidal sinus treatment (EPSiT) in the management of pilonidal sinus disease", "firstAuthor": "Li", "multipleAuthors": true, "journal": "Langenbecks Arch Surg", "year": 2026, "design": "meta-analysis", "n": null, "nField": "not-reported", "population": "patients with pilonidal sinus disease", "intervention": "laser treatment (SiLaC - sinus laser associated closure)", "comparator": "endoscopic pilonidal sinus treatment (EPSiT)", "primaryOutcome": "operative time, cure rate, recurrence rate, complication rate, and wound healing time", "result": "SiLaC had shorter operative time (18.02 min vs 30.11 min) but similar cure rate (86% vs 88%), recurrence rate (11% vs 9%), complication rate (10% vs 7%), and healing time (30.08 vs 26.55 days) compared to EPSiT", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was an indirect comparison of mostly single-arm studies with very high statistical heterogeneity and no direct head-to-head trials.", "directness": "indirect", "limitations": "The authors state this is an indirect comparative analysis limited by lack of direct comparative trials, based on predominantly single-arm studies with high heterogeneity (I2 up to 99%).", "followUp": "", "plainFinding": "Comparable healing to endoscopic surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41964736/", "sourceText": "BACKGROUND: Various surgical modalities exist for the management of pilonidal sinus disease (PSD), with an increasing trend toward minimally invasive techniques. Sinus Laser associated Closure (SiLaC) and endoscopic pilonidal sinus treatment (EPSiT) are two minimally invasive techniques widely used in clinical practice. However, a systematic comparison of both techniques is lacking. This study conducted separate single-arm analyses of both techniques to compare their efficacy and safety. OBJECTIVE: A systematic literature search was performed across electronic databases including Web of Science, Embase, the Cochrane Library, Google Scholar and PubMed to identify relevant studies investigating SiLaC versus EPSiT for PSD. The primary outcome measures included operative time, cure rate, recurrence rate, postoperative complication rate, and total wound healing time. RESULTS: A total of 29 studies were included. The mean operative time was 18.02 min (95% CI:13.42–22.62; I2 = 99.4%; P < 0.001) for SiLaC and 30.11 min (95% CI: 21.33–38.88; I² = 98.5%; P < 0.001) for EPSiT. The cure rate was 86% (95% CI: 80–91%; I2 =92%; P < 0.001) in the SiLaC and 88% (95% CI: 83–94%; I² = 87.1%; P < 0.001) in the EPSiT group. The pooled recurrence rate was 11% (95% CI: 6–15%; I2 = 90.4%; < 0.001) for SiLaC and 9% (95% CI: 5–12%; I² = 82.9%; P < 0.001) for EPSiT. The complication rate was 10% (95% CI: 7–14%; I2 = 79.6%; P < 0.001) for SiLaC and 7% (95% CI: 1–15%; I² = 74.7%; P < 0.05) for EPSiT. The mean total healing time was 30.08 days (95% CI: 22.73–37.43%; I2 = 99.2%; P < 0.001) for SiLaC and 26.55 days (95% CI: 24.40–28.70; I² = 90.9%; P < 0.001) for EPSiT. CONCLUSION: This indirect comparative analysis suggests comparable efficacy between SiLaC and EPSiT for PSD based on currently available, predominantly single-arm studies. These findings, limited by the lack of direct comparative trials, highlight the urgent need for prospective investigations to establish robust comparative effectiveness.", "provenance": [ { "field": "population", "quote": "Various surgical modalities exist for the management of pilonidal sinus disease (PSD)" }, { "field": "intervention", "quote": "Sinus Laser associated Closure (SiLaC)" }, { "field": "comparator", "quote": "endoscopic pilonidal sinus treatment (EPSiT)" }, { "field": "primaryOutcome", "quote": "The primary outcome measures included operative time, cure rate, recurrence rate, postoperative complication rate, and total wound healing time." }, { "field": "result", "quote": "The mean operative time was 18.02 min (95% CI:13.42–22.62; I2 = 99.4%; P < 0.001) for SiLaC and 30.11 min (95% CI: 21.33–38.88; I² = 98.5%; P < 0.001) for EPSiT." }, { "field": "result", "quote": "The cure rate was 86% (95% CI: 80–91%; I2 =92%; P < 0.001) in the SiLaC and 88% (95% CI: 83–94%; I² = 87.1%; P < 0.001) in the EPSiT group." }, { "field": "result", "quote": "The pooled recurrence rate was 11% (95% CI: 6–15%; I2 = 90.4%; < 0.001) for SiLaC and 9% (95% CI: 5–12%; I² = 82.9%; P < 0.001) for EPSiT." }, { "field": "result", "quote": "The mean total healing time was 30.08 days (95% CI: 22.73–37.43%; I2 = 99.2%; P < 0.001) for SiLaC and 26.55 days (95% CI: 24.40–28.70; I² = 90.9%; P < 0.001) for EPSiT." }, { "field": "n", "quote": "A total of 29 studies were included." } ] }, { "id": "pmid:41901600", "pmid": "41901600", "doi": "10.3390/medicina62030518", "nctId": null, "pmcid": "PMC13028323", "title": "The New Minimally Invasive Techniques for Pilonidal Sinus Disease Surgery: Choosing the Right Technique for the Right Patient-A Narrative Review", "firstAuthor": "Matteucci", "multipleAuthors": true, "journal": "Medicina (Kaunas)", "year": 2026, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus disease", "intervention": "minimally invasive techniques including laser-assisted treatment", "comparator": "off-midline flap surgery and midline primary closure", "primaryOutcome": "healing time, recurrence, complications and patient satisfaction", "result": "faster recovery and high short-term satisfaction in selected primary cases, but less proven long-term than flap surgery for complex or recurrent disease", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this is a narrative review (not systematic or meta-analysis) that itself says long-term evidence for minimally invasive techniques like laser is limited", "directness": "direct", "limitations": "narrative (non-systematic) review methodology; abstract notes limited long-term evidence for minimally invasive approaches and calls for high-quality comparative studies", "followUp": "", "plainFinding": "Faster recovery, unclear long-term results.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41901600/", "sourceText": "Background and Objectives: Pilonidal sinus disease (PSD) is a common condition affecting predominantly young adults and it is associated with a substantial impact on quality of life. Despite the wide range of available surgical options, optimal management remains controversial due to heterogeneous recurrence rates, wound complications and prolonged recovery. Over the last decade, a paradigm shift has occurred from midline excision toward off-midline closure techniques and minimally invasive procedures. This narrative review aims to critically appraise contemporary surgical strategies for PSD, comparing outcomes, indications and limitations, with particular emphasis on patient selection. Materials and Methods: A narrative review of the literature was conducted using PubMed, Scopus, and major guideline repositories. Relevant randomized controlled trials, systematic reviews, meta-analyses, observational studies and national and international guidelines were reviewed and synthesized, with a focus on healing time, recurrence, postoperative complications and patient-reported outcomes. Results: Midline primary closure is consistently associated with higher recurrence and complication rates and is no longer recommended. Off-midline flap techniques provide the most durable results in recurrent or complex disease. Minimally invasive approaches, including endoscopic and laser-assisted techniques, offer faster recovery and high short-term patient satisfaction in selected primary cases, but should not be considered equivalent to flap surgery in complex or recurrent PSD due to limited long-term evidence. Current guidelines uniformly advocate individualized, patient-tailored treatment strategies and discourage midline closure. Conclusions: Surgical management of PSD should be individualized according to disease complexity, prior interventions and patient expectations. While minimally invasive techniques represent an attractive option for selected primary disease, off-midline flap procedures remain the standard of care for extensive or recurrent cases. High-quality comparative studies with standardized outcome definitions and long-term follow-up are required to refine treatment algorithms.", "provenance": [ { "field": "population", "quote": "Pilonidal sinus disease (PSD) is a common condition affecting predominantly young adults" }, { "field": "intervention", "quote": "Minimally invasive approaches, including endoscopic and laser-assisted techniques" }, { "field": "comparator", "quote": "Off-midline flap techniques provide the most durable results in recurrent or complex disease" }, { "field": "primaryOutcome", "quote": "with a focus on healing time, recurrence, postoperative complications and patient-reported outcomes" }, { "field": "result", "quote": "offer faster recovery and high short-term patient satisfaction in selected primary cases, but should not be considered equivalent to flap surgery in complex or recurrent PSD due to limited long-term evidence" } ] }, { "id": "pmid:41834241", "pmid": "41834241", "doi": "10.1002/wjs.70299", "nctId": null, "pmcid": null, "title": "Long-Term Outcomes of Sinus Laser-Assisted Closure in Primary Versus Recurrent Sacrococcygeal Pilonidal Sinus Disease: A Retrospective Cohort Study", "firstAuthor": "van Kempen", "multipleAuthors": true, "journal": "World J Surg", "year": 2026, "design": "retrospective", "n": 267, "nField": "reported", "population": "patients with sacrococcygeal pilonidal sinus disease, either new (primary) or returning (recurrent) cases", "intervention": "laser treatment to close the pilonidal sinus tract (SiLaC)", "comparator": "primary disease versus recurrent disease", "primaryOutcome": "disease coming back (recurrence) after laser treatment", "result": "recurrence was much more common and came back faster in recurrent disease than in primary disease, though repeat laser treatments eventually healed most patients in both groups", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this is a retrospective single-center study without a comparison treatment group, so it can show patterns but not prove laser treatment is better than other options.", "directness": "direct", "limitations": "retrospective design, single center, no comparator treatment group, some loss to follow-up (90.3% completion)", "followUp": "median of 4.0 years (IQR: 3.6-5.0 years)", "plainFinding": "Laser works well first-time, worse if recurrent.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41834241/", "sourceText": "BACKGROUND: Sinus laser-assisted closure (SiLaC) demonstrates favorable outcomes for primary sacrococcygeal pilonidal sinus disease (SPSD), yet its efficacy in recurrent disease remains undefined. This study compared long-term outcomes following SiLaC in primary versus recurrent SPSD, hypothesizing that recurrent disease would predict inferior results. METHODS: This retrospective cohort study analyzed 267 consecutive patients undergoing SiLaC at a single center (July 2019-August 2022), stratified by disease status: primary (n = 214) versus recurrent (n = 53). The primary outcome, disease recurrence, was assessed using Kaplan-Meier analysis; secondary outcomes included healing rates, healing time, and complications. Univariable risk factor analysis was performed. Follow-up through telephone interviews and review of medical records achieved a 90.3% completion rate at a median of 4.0 years (IQR: 3.6-5.0 years). RESULTS: Recurrence rates were significantly higher in recurrent versus primary disease (RR 1.76, 95%CI: 1.30-2.40, p = 0.001), with 12-month rates of 34.8% versus 16.8% respectively. At the final follow-up, the recurrence rate was 34.6% for primary disease and 60.8% for recurrent disease. The time to recurrence was accelerated in recurrent cases (median, 11.4 vs. 14.0 months, p < 0.05). Despite comparable initial healing rates (75.4% primary, 68.0% recurrent), recurrent disease required 10 additional days for complete healing (56 vs. 46 days, p < 0.001). Sequential SiLaC procedures, when necessary, achieved final healing rates exceeding 90% in both groups with minimal complications (5.8%). Three factors predicted recurrence: recurrent disease status in all patients; within recurrent cases, symptom duration greater than 38 weeks (RR 2.14) and four or more medial openings (RR 2.07); all p < 0.05. CONCLUSION: SiLaC demonstrated acceptable recurrence rates for primary SPSD comparable to other minimally invasive techniques at long-term follow-up, but significantly poorer outcomes in recurrent disease. Therefore, SiLaC may be considered a feasible first-line option for primary SPSD, while recurrent cases require careful patient selection and consideration of alternative treatments.", "provenance": [ { "field": "n", "quote": "analyzed 267 consecutive patients undergoing SiLaC" }, { "field": "population", "quote": "primary (n = 214) versus recurrent (n = 53)" }, { "field": "intervention", "quote": "Sinus laser-assisted closure (SiLaC)" }, { "field": "comparator", "quote": "compared long-term outcomes following SiLaC in primary versus recurrent SPSD" }, { "field": "primaryOutcome", "quote": "The primary outcome, disease recurrence, was assessed using Kaplan-Meier analysis" }, { "field": "result", "quote": "Recurrence rates were significantly higher in recurrent versus primary disease (RR 1.76, 95%CI: 1.30-2.40, p = 0.001), with 12-month rates of 34.8% versus 16.8% respectively." }, { "field": "result", "quote": "Sequential SiLaC procedures, when necessary, achieved final healing rates exceeding 90% in both groups with minimal complications (5.8%)." }, { "field": "followUp", "quote": "median of 4.0 years (IQR: 3.6-5.0 years)" } ] }, { "id": "pmid:41804956", "pmid": "41804956", "doi": "10.1177/25785478261428953", "nctId": null, "pmcid": null, "title": "Localization-Based Surgical Approaches in Pilonidal Sinus Treatment: A Comparative Study of Laser Therapy and Alternative Techniques", "firstAuthor": "Tekin", "multipleAuthors": true, "journal": "Photobiomodul Photomed Laser Surg", "year": 2026, "design": "retrospective", "n": null, "nField": "not-reported", "population": "patients with pilonidal sinus disease (chronic inflammatory condition near the tailbone)", "intervention": "laser therapy", "comparator": "microsinusectomy, surgical resection with phenol application, and platelet-rich plasma (PRP)", "primaryOutcome": "recurrence of pilonidal sinus after treatment", "result": "laser therapy had the lowest overall recurrence rate, but the highest recurrence rate in mixed-location disease", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a non-randomized comparison without reported group sizes or statistical testing, so the result may not be reliable.", "directness": "direct", "limitations": "Abstract does not report sample size, statistical significance, or randomization; outcomes varied by anatomical location suggesting confounding.", "followUp": "a minimum of two years", "plainFinding": "Fewer recurrences overall, but worse for mixed-location cysts.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41804956/", "sourceText": "BACKGROUND: Pilonidal sinus disease (PSD) is a chronic inflammatory condition most commonly observed in the sacrococcygeal region and predominantly affecting young individuals. Although various treatment modalities are currently employed, none has demonstrated definitive superiority, as recurrence rates-an important indicator of treatment success-remain considerable. OBJECTIVE: This study aimed to evaluate the comparative treatment success of commonly used PSD management strategies based on postoperative recurrence rates. METHODS: Patients with comparable sociodemographic characteristics were allocated into four treatment groups: microsinusectomy, surgical resection followed by phenol application, platelet-rich plasma (PRP), and laser therapy. All patients were followed for a minimum of two years. Treatment outcomes were assessed primarily in terms of postoperative recurrence. RESULTS: Among the evaluated modalities, laser therapy demonstrated the lowest overall recurrence rate (15.6%). However, in cases of mixed-location PSD, laser treatment was associated with the highest recurrence rate (83.3%). These findings suggest that treatment success may vary depending on anatomical localization. CONCLUSION: Laser therapy may provide favorable outcomes in selected anatomical locations but appears less effective in mixed-location disease. Detailed anatomical classification should be incorporated into future studies, and outcomes should be reassessed using different laser treatment protocols to optimize patient selection and therapeutic success.", "provenance": [ { "field": "population", "quote": "Patients with comparable sociodemographic characteristics were allocated into four treatment groups" }, { "field": "intervention", "quote": "laser therapy" }, { "field": "comparator", "quote": "microsinusectomy, surgical resection followed by phenol application, platelet-rich plasma (PRP), and laser therapy" }, { "field": "primaryOutcome", "quote": "Treatment outcomes were assessed primarily in terms of postoperative recurrence." }, { "field": "result", "quote": "laser therapy demonstrated the lowest overall recurrence rate (15.6%). However, in cases of mixed-location PSD, laser treatment was associated with the highest recurrence rate (83.3%)." }, { "field": "followUp", "quote": "All patients were followed for a minimum of two years." } ] }, { "id": "pmid:41461191", "pmid": "41461191", "doi": "10.1055/a-2773-3657", "nctId": null, "pmcid": null, "title": "In-Office Pit Excision for Pilonidal Disease Using Needle-Free Local Anesthesia: A Minimally Invasive, Non-Operative Treatment Approach", "firstAuthor": "Stoeckel", "multipleAuthors": true, "journal": "Eur J Pediatr Surg", "year": 2026, "design": "case-series", "n": 100, "nField": "reported", "population": "patients with pilonidal disease (gluteal crease pits), mean age 18.1 years", "intervention": "in-office pit excision combined with laser follicle ablation and needle-free local anesthesia", "comparator": "none - single-arm study with no comparison group", "primaryOutcome": "whether all pits healed at follow-up", "result": "60% of patients healed all pits at first follow-up, and 88% ultimately healed all of their pits", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a single-arm case series without a control group, with 25% of patients lost to follow-up, so the true healing rate and the specific effect of laser cannot be confirmed.", "directness": "indirect", "limitations": "No comparator group, 25 of 130 patients lost to follow-up, and laser ablation was combined with punch excision so its individual effect cannot be separated.", "followUp": "return in 6 to 8 weeks", "plainFinding": "Most pits healed after combined laser and excision.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41461191/", "sourceText": "INTRODUCTION: Treatment of pilonidal disease traditionally involves an operation under general anesthesia, which may have a period of postoperative disability and a significant recurrence rate. We report a novel treatment for pilonidal disease performed in-office using a pneumatic lidocaine injection device, requiring no pain medication or activity restrictions-supporting a non-operative standard of care. METHODS: Patients with gluteal crease pits at our Pilonidal Care Clinic were offered pit excision as standard care. Prospective data on demographics, pain scores (0-10), and outcomes were collected in REDCap. Under sterile conditions, patients received 1% buffered lidocaine via pneumatic injection. Laser follicle ablation was followed by punch excision (1.5 or 2 mm) of full-thickness pit epithelium. Sinus tracts were probed but not excised. Patients were asked to wash the area twice daily, maintain normal activities, and return in 6 to 8 weeks. Patients requiring nidus incision and drainage (I&D) were excluded. RESULTS: About 130 patients underwent this technique between February and June 2024; 100 were included in the analysis (5 excluded for concurrent I&D, 25 lost to follow-up). Mean age was 18.1 years; 50% were male. At subsequent follow-up, 60% patients healed all pits, resolving their condition, with 64% (144/224) of all pits healed. Patients with three or more pits were more likely to need an additional pit excision. Mean procedure pain score was 1.6/10 (SD 1.21); no patient used pain medication or experienced disability. Ultimately, 88% of patients healed all of their pits. CONCLUSION: Pilonidal disease may be resolved non-operatively in a single outpatient clinic visit, without even a shot.", "provenance": [ { "field": "n", "quote": "100 were included in the analysis" }, { "field": "population", "quote": "Mean age was 18.1 years; 50% were male." }, { "field": "intervention", "quote": "Laser follicle ablation was followed by punch excision (1.5 or 2 mm) of full-thickness pit epithelium." }, { "field": "comparator", "quote": "About 130 patients underwent this technique between February and June 2024; 100 were included in the analysis" }, { "field": "primaryOutcome", "quote": "60% patients healed all pits, resolving their condition, with 64% (144/224) of all pits healed." }, { "field": "result", "quote": "Ultimately, 88% of patients healed all of their pits." }, { "field": "followUp", "quote": "return in 6 to 8 weeks" } ] }, { "id": "pmid:41397828", "pmid": "41397828", "doi": "10.3760/cma.j.cn441530-20250805-00292", "nctId": null, "pmcid": null, "title": "[Clinical efficacy of laser ablation and closure in the treatment of sacrococcygeal pilonidal disease and analysis of risk factors for postoperative recurrence in male patients]", "firstAuthor": "Li", "multipleAuthors": true, "journal": "Zhonghua Wei Chang Wai Ke Za Zhi", "year": 2025, "design": "retrospective", "n": 369, "nField": "reported", "population": "patients with sacrococcygeal pilonidal disease (mostly male, some under 18)", "intervention": "laser ablation and closure surgery", "comparator": "none (single-arm, risk factor analysis for recurrence)", "primaryOutcome": "wound healing rate and postoperative recurrence", "result": "all wounds healed, 5.1% recurrence, higher recurrence risk in those ≤18 years old or with prior SPD surgery", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective study without a comparison group, so it cannot show how laser treatment compares to other treatments.", "directness": "direct", "limitations": "Retrospective design, no control group, single center, recurrence risk factor analysis limited to males.", "followUp": "not specified beyond recurrence tracking", "plainFinding": "High healing, low recurrence with laser.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41397828/", "sourceText": "Objective: To investigate the clinical efficacy and safety of laser ablation and closure for the treatment of sacrococcygeal pilonidal disease (SPD) and to analyze risk factors for postoperative recurrence in male patients. Methods: A retrospective observational study was conducted to collect clinical data of 369 patients with SPD who underwent laser ablation and closure in the Anorectal Department of Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine between March 2019 and December 2024. Perioperative outcomes and postoperative recurrence were analyzed. The cohort included 313 males and 56 females, with 43 patients aged ≤18 years. The median body mass index was 26.3 (IQR: 22.9, 29.6) kg/m², and the median disease duration was 28 months (IQR: 4, 76). Among them, 218 male SPD patients who underwent surgery received preoperative sex hormone testing. A logistic regression model was used to analyze the risk factors for recurrence. Results: All patients completed the surgery. The median intraoperative ablation energy delivered was 426.8 (IQR: 243.9, 683.9) J, with no occurrence of major intraoperative complications. Postoperatively, a total of 31 patients (8.4%) required analgesic medication. Within the first postoperative week, 12 patients experienced wound oozing/bleeding; hemostasis was achieved by compression alone in 5 cases, while the remaining 7 instances required suture hemostasis after failed compression attempts. No other complications were observed. The median postoperative hospital stay was 6 (IQR: 4, 8) days, and the median time to return to regular work and life was 7 (IQR: 5, 12) days. The wound healing rate was 100%, with a median wound healing time of 35 (IQR: 30, 42) days. Postoperative recurrence occurred in 19 patients (5.1%), all of whom were male. Multivariate logistic regression analysis identified age ≤18 years (OR = 4.764, 95%CI: 2.424-34.905, P = 0.008) and a history of previous SPD surgery (OR = 5.078, 95%CI: 1.431-18.019, P = 0.012) as independent risk factors for recurrence after SPD laser ablation and closure surgery. Conclusion: Laser ablation and closure are safe, effective, and minimally invasive treatments for SPD. However, particular attention should be paid to the risk of recurrence in young male patients and those with a history of previous SPD surgery.", "provenance": [ { "field": "n", "quote": "collect clinical data of 369 patients with SPD who underwent laser ablation and closure" }, { "field": "population", "quote": "The cohort included 313 males and 56 females, with 43 patients aged ≤18 years." }, { "field": "intervention", "quote": "laser ablation and closure for the treatment of sacrococcygeal pilonidal disease (SPD)" }, { "field": "comparator", "quote": "A retrospective observational study was conducted to collect clinical data of 369 patients with SPD who underwent laser ablation and closure" }, { "field": "primaryOutcome", "quote": "The wound healing rate was 100%, with a median wound healing time of 35 (IQR: 30, 42) days. Postoperative recurrence occurred in 19 patients (5.1%)" }, { "field": "result", "quote": "The wound healing rate was 100%, with a median wound healing time of 35 (IQR: 30, 42) days. Postoperative recurrence occurred in 19 patients (5.1%), all of whom were male." } ] }, { "id": "pmid:41365098", "pmid": "41365098", "doi": "10.1016/j.jss.2025.11.005", "nctId": null, "pmcid": null, "title": "Identifying Predictors of Recurrent Pilonidal Disease in Adolescents and Young Adults: A Secondary Analysis of a Randomized Controlled Trial", "firstAuthor": "Turpin", "multipleAuthors": true, "journal": "J Surg Res", "year": 2026, "design": "rct", "n": 200, "nField": "reported", "population": "adolescents and young adults aged 11 to 21 with a history of at least one episode of pilonidal disease, not currently active", "intervention": "laser hair removal added to standard treatment", "comparator": "standard treatment alone", "primaryOutcome": "disease recurrence within 1 year", "result": "laser hair treatment was linked to lower odds of recurrence overall, but this benefit was only seen in privately insured patients, not publicly insured patients", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "this is a secondary analysis of a randomized trial using statistical adjustment, so the insurance-based subgroup findings are less certain than the trial's main result.", "directness": "direct", "limitations": "this is a secondary/exploratory analysis of a trial looking at predictors of recurrence, not the primary trial outcome report, and it is from a single institution.", "followUp": "1 y", "plainFinding": "Fewer recurrences, but only if privately insured", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41365098/", "sourceText": "INTRODUCTION: Pilonidal disease is a common condition affecting adolescents and young adults with high recurrence rates and disease-associated morbidity. Identification of patient-specific factors and treatments associated with decreased disease recurrence can assist providers with treatment selection and patient counseling. MATERIALS AND METHODS: This is a planned secondary analysis of a single institution, randomized controlled trial which compared laser depilation as an adjunct to standard care versus standard care alone. Inclusion criteria were patients 11 to 21 y of age with a history of at least 1 episode of pilonidal disease, without active disease. Patients were randomized to receive laser depilation in conjunction with standard treatment versus standard treatment alone. Multivariable logistic regression modeling was performed to identify variables independently associated with disease recurrence including laser depilation, patient variables (biologic sex, body mass index, prior episodes of disease, prior surgical treatment, race and ethnicity, health insurance status), and annual family income. RESULTS: Complete 1-y follow-up data to be included in the multivariable analysis were available for 200 patients in the trial. After adjusting for sex, body mass index, prior episodes of disease, prior surgical treatment, race and ethnicity, type of health insurance, and household income, laser hair treatment was strongly associated with decreased odds of disease recurrence within 1 y (odds ratio [OR], 0.26 [95% confidence interval (CI), 0.12-0.58]; P = 0.001). After adjusting for other covariables, there was a significant interaction between laser hair treatment and health insurance type. Laser hair treatment was significantly associated with lower odds of disease recurrence in patients who were privately insured (OR, 0.29 [95% CI, 0.16-0.55], P < 0.001) but was not associated with lower disease recurrence in those who were publicly insured (OR, 1.20 [95% CI, 0.63-2.28], P = 0.58). CONCLUSIONS: Laser depilation is associated with decreased pilonidal disease recurrence. However, there may be heterogeneity of treatment effect based on insurance status with laser depilation decreasing recurrence in patients with private insurance and being less effective in patients with public insurance. This heterogeneity of treatment effect may be related to barriers to care and social determinants of health and warrants further investigation.", "provenance": [ { "field": "population", "quote": "patients 11 to 21 y of age with a history of at least 1 episode of pilonidal disease, without active disease" }, { "field": "intervention", "quote": "laser depilation as an adjunct to standard care" }, { "field": "comparator", "quote": "standard care alone" }, { "field": "primaryOutcome", "quote": "disease recurrence" }, { "field": "n", "quote": "Complete 1-y follow-up data to be included in the multivariable analysis were available for 200 patients in the trial." }, { "field": "result", "quote": "laser hair treatment was strongly associated with decreased odds of disease recurrence within 1 y (odds ratio [OR], 0.26 [95% confidence interval (CI), 0.12-0.58]; P = 0.001)" }, { "field": "result", "quote": "Laser hair treatment was significantly associated with lower odds of disease recurrence in patients who were privately insured (OR, 0.29 [95% CI, 0.16-0.55], P < 0.001) but was not associated with lower disease recurrence in those who were publicly insured (OR, 1.20 [95% CI, 0.63-2.28], P = 0.58)." }, { "field": "followUp", "quote": "1-y follow-up data" } ] }, { "id": "pmid:41340801", "pmid": "41340801", "doi": "10.20471/acc.2025.64.01.17", "nctId": null, "pmcid": "PMC12671715", "title": "LASER SURGERY FOR PILONIDAL DISEASE - A NOVEL MINIMALLY INVASIVE PROCEDURE", "firstAuthor": "Grgić", "multipleAuthors": true, "journal": "Acta Clin Croat", "year": 2025, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal cysts/sinus disease", "intervention": "laser treatment of the pilonidal sinus tract", "comparator": "other surgical treatments (e.g. excision, flap surgery, phenol)", "primaryOutcome": "", "result": "abstract describes the treatment approach but does not report specific outcome data or results", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a narrative review describing an experience with laser treatment but reports no outcome data, numbers, or comparative results.", "directness": "direct", "limitations": "No patient numbers, no outcome measures, no follow-up, and no quantitative results are reported in this abstract.", "followUp": "", "plainFinding": "No results reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41340801/", "sourceText": "Pilonidal disease (PD) is a common inflammatory disease of the gluteal region with an incidence of 26/100000 and usually occurs in young males (15-30 years old). The etiology of pilonidal disease is unclear, but literature describes a wide range of factors such as keratin plugs, foreign substance reaction related to hairs, as well as dermatopathy and debris in hair follicles in the natal cleft. PD and also its classic treatment can cause discomfort and very much deteriorate the patient's quality of life. There are many possibilities (conservative or surgical) in the treatment of pilonidal disease, but there is no gold standard. In the acute phase (abscess), surgical incision with pus evacuation and antibiotic therapy is enough. In the chronic phase, there are many possibilities like phenol treatment, surgical excision with lay open and secondary wound healing. There are many reconstructive techniques such as Karydakis, V-Y flap or Limberg flap. A recently minimally invasive technique such as endoscopic surgical procedure or filling pilonidal tract with fibrin glue or phenol have been introduced. We present our experience with laser treatment (Biolitec, Germany) of pilonidal sinus disease.", "provenance": [ { "field": "population", "quote": "Pilonidal disease (PD) is a common inflammatory disease of the gluteal region" }, { "field": "intervention", "quote": "We present our experience with laser treatment (Biolitec, Germany) of pilonidal sinus disease." }, { "field": "comparator", "quote": "There are many reconstructive techniques such as Karydakis, V-Y flap or Limberg flap." }, { "field": "result", "quote": "We present our experience with laser treatment (Biolitec, Germany) of pilonidal sinus disease." } ] }, { "id": "pmid:41316137", "pmid": "41316137", "doi": "10.1186/s12893-025-03319-4", "nctId": null, "pmcid": "PMC12661896", "title": "Combined laser ablation and pit excision for pilonidal sinus: effectiveness, quality of recovery, and patient-reported outcomes", "firstAuthor": "Canturk", "multipleAuthors": true, "journal": "BMC Surg", "year": 2025, "design": "retrospective", "n": 39, "nField": "reported", "population": "adults with pilonidal sinus disease", "intervention": "diode laser ablation combined with pit excision", "comparator": "none (single-arm cohort, no comparator group)", "primaryOutcome": "recurrence and treatment success (no recurrence without re-intervention)", "result": "84.6% had treatment success and 15.4% had recurrence, with high patient-reported recovery and satisfaction scores", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small, retrospective, single-center study with no comparison group, so results may not reliably predict how laser treatment compares to other options.", "directness": "direct", "limitations": "Retrospective design, modest sample size, single-center, no comparator group explicitly described.", "followUp": "13.6 ± 3.6 months", "plainFinding": "Good healing, low recurrence with laser.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41316137/", "sourceText": "BACKGROUND: This retrospective study aimed to evaluate the efficacy, safety, and patient-reported long-term results of a minimally invasive method of diode laser ablation combined with pit excision for pilonidal sinus disease, reveal predictive factors affecting treatment success, and quantitatively examine patient satisfaction and quality of life dimensions. METHODS: Fifty-four adults were treated consecutively, and the primary analysis included 39 patients who 6month patientreported outcomes (PROs: QoR15, SAPS, PROMIS Global10) assessed by an independent investigator. The primary endpoints were recurrence and treatment success (no recurrence without re-intervention). Delayed healing was a composite of epithelialization > 30 days or discharge > 14 days. Exploratory subgroup analyses (sex and BMI) reported effect sizes with Benjamini-Hochberg-adjusted qvalues. Receiver operating characteristic (ROC) curve analysis assessed PRO discrimination for recurrence with 95% confidence intervals (CIs). RESULTS: Mean followup was 13.6 ± 3.6 months; treatment success 84.6% (33/39), recurrence 15.4% (6/39), and delayed healing 20.5% (8/39). Mean PROs were: QoR15 136.8 ± 19.9, SAPS 30.4 ± 4.3, PROMIS 46.2 ± 6.8; early postoperative pain (VAS) 1.9 ± 1.3. QoR15, SAPS, and PROMIS correlated inversely with recurrence (r = - 0.46 to - 0.36; all p < 0.05) and showed AUCs of 0.79 (95% CI 0.65-0.93), 0.73 (0.58-0.88), and 0.70 (0.54-0.86), respectively. Age was associated with a longer recovery time (p = 0.002). No material differences in PROs by sex or BMI were observed after multiplicity control. CONCLUSIONS: In this single-center consecutive cohort, combined diode laser ablation with a pit excision technique was associated with short perioperative timelines, high patient-reported recovery/satisfaction, and acceptable mid-term recurrence, whereas PRO scores demonstrated fair discrimination for recurrence. Findings should be interpreted cautiously given the retrospective design and modest sample size; prospective, adequately powered studies are needed to validate the prognostic performance and comparative effectiveness.", "provenance": [ { "field": "population", "quote": "Fifty-four adults were treated consecutively" }, { "field": "intervention", "quote": "minimally invasive method of diode laser ablation combined with pit excision for pilonidal sinus disease" }, { "field": "comparator", "quote": "This retrospective study aimed to evaluate the efficacy, safety, and patient-reported long-term results of a minimally invasive method of diode laser ablation combined with pit excision for pilonidal sinus disease" }, { "field": "primaryOutcome", "quote": "The primary endpoints were recurrence and treatment success (no recurrence without re-intervention)." }, { "field": "result", "quote": "treatment success 84.6% (33/39), recurrence 15.4% (6/39), and delayed healing 20.5% (8/39)" }, { "field": "n", "quote": "the primary analysis included 39 patients" }, { "field": "followUp", "quote": "Mean followup was 13.6 ± 3.6 months" } ] }, { "id": "pmid:41146596", "pmid": "41146596", "doi": "10.1111/codi.70282", "nctId": null, "pmcid": null, "title": "Comparison of short- and long-term outcomes of diode laser vs. crystallized phenol treatment for pilonidal sinus disease: A propensity score-matched multicentre study", "firstAuthor": "Bilgin", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2025, "design": "retrospective", "n": 644, "nField": "reported", "population": "young adults with pilonidal sinus disease", "intervention": "diode laser ablation", "comparator": "crystallized phenol application", "primaryOutcome": "recovery, recurrence, complications, healing time, and return to daily activities", "result": "Complications were more common and pain scores higher with laser, with slower return to daily activities, but healing was faster and fewer sessions needed; recurrence and recovery rates were similar between groups", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a retrospective study comparing two treatments without a true no-treatment control, so it cannot show whether laser works better than doing nothing, only how it compares to phenol.", "directness": "indirect", "limitations": "Retrospective design with propensity score matching rather than randomization; compares two active treatments rather than laser versus no treatment or surgery.", "followUp": "45 months (laser) and 40 months (phenol)", "plainFinding": "Similar recurrence; laser healed faster, more pain.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41146596/", "sourceText": "AIM: Pilonidal sinus disease (PSD) primarily affects young adults; rapid recovery is essential and yet lacks a standardized treatment approach. While excisional techniques delay recovery, minimally invasive options like laser ablation and phenol application are gaining interest, yet comparative long-term evidence is scarce. This study compared short- and long-term outcomes of laser versus phenol treatment in PSD. METHOD: In this multicentre retrospective cohort study (Nov. 2017-Sep. 2024), patients treated with laser or phenol were included. 1:3 propensity score matching using the nearest neighbour algorithm was performed based on age, gender, prior surgical history and year of operation. Categorical variables were analysed using chi-squared or Fisher's exact tests, whereas continuous variables were compared using Student's t-test or Mann-Whitney U test depending on distribution normality. RESULTS: Out of 897 eligible patients, 644 were included (median age: 26 years, body mass index [BMI]: 26.2 kg/m2, male-to-female ratio: 4:1). The number of sinuses/pits was 2-3 in both groups. Operating time was significantly longer in the laser group. Complications occurred in 6.8% of laser patients, whereas none were reported in the phenol group. Pain scores were higher in the laser group (2 [1-3] vs. 1 [0-2]). Median follow-up was 45 months (laser) and 40 months (phenol). Return to daily activities was delayed in the laser group, whereas complete healing was slower in the phenol group. Readmission, recurrence and recovery rates were comparable (85%-86%). CONCLUSION: Both treatments demonstrated low complication and recurrence rates with high recovery rates. Laser favoured faster healing and fewer sessions, whereas phenol allowed for shorter procedures and earlier return to daily life.", "provenance": [ { "field": "population", "quote": "Pilonidal sinus disease (PSD) primarily affects young adults" }, { "field": "intervention", "quote": "patients treated with laser or phenol were included" }, { "field": "comparator", "quote": "patients treated with laser or phenol were included" }, { "field": "primaryOutcome", "quote": "This study compared short- and long-term outcomes of laser versus phenol treatment in PSD." }, { "field": "result", "quote": "Complications occurred in 6.8% of laser patients, whereas none were reported in the phenol group. Pain scores were higher in the laser group (2 [1-3] vs. 1 [0-2]). Median follow-up was 45 months (laser) and 40 months (phenol). Return to daily activities was delayed in the laser group, whereas complete healing was slower in the phenol group. Readmission, recurrence and recovery rates were comparable (85%-86%)." }, { "field": "n", "quote": "897 eligible patients, 644 were included" }, { "field": "followUp", "quote": "Median follow-up was 45 months (laser) and 40 months (phenol)." } ] }, { "id": "pmid:41135869", "pmid": "41135869", "doi": "10.1016/j.jpedsurg.2025.162747", "nctId": null, "pmcid": null, "title": "Topical lidocaine or not for laser follicle ablation in pilonidal disease: A prospective, randomized, double-blinded trial", "firstAuthor": "Stoeckel", "multipleAuthors": true, "journal": "J Pediatr Surg", "year": 2026, "design": "rct", "n": 20, "nField": "reported", "population": "patients having laser treatment for pilonidal disease", "intervention": "numbing cream (lidocaine) applied before laser follicle ablation", "comparator": "placebo cream before laser follicle ablation", "primaryOutcome": "pain score reported after the laser procedure", "result": "no significant difference in pain scores between lidocaine cream and placebo", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "Very small crossover trial testing a numbing cream, not the effectiveness of laser treatment itself for pilonidal disease.", "directness": "indirect", "limitations": "Small sample of 20, only measured pain during the procedure, not disease outcomes like healing or recurrence.", "followUp": "", "plainFinding": "Numbing cream didn't reduce procedure pain.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41135869/", "sourceText": "BACKGROUND: Laser follicle ablation is a significant component of the care in pilonidal disease, but may be uncomfortable secondary to absorption of the light energy by pigment present in the underlying skin. Multiple methods have been proposed to ameliorate the discomfort, including the pre-procedure application of topical lidocaine creams; however, little data exists as to the efficacy of the creams, which must be applied 30-40 min prior to laser treatment. We studied the efficacy of a topical local anesthetic cream for this purpose. METHODS: A prospective, double-blinded, randomized case-control trial was conducted and included patients presenting to the pilonidal care clinic for laser follicle ablation. Power calculation was based on a superiority design where a sample size of 20 participants had 80 % power to detect a standardized difference of 0.67 in pain scores between treatments (difference in means = 2 and standard deviation = 3) using a paired t-test with 5 % alpha. Patients were randomized to blindly receive topical anesthetic cream (LMX, 4 % topical lidocaine, Ferndale Laboratories Inc.) or placebo and crossed over between study arms to serve as their own control for their subsequent laser follicle ablation, 6-8 weeks later. The topical cream remained applied to each patients' gluteal crease for 30-40 min and was then removed prior to laser follicle ablation with accompanying cold air by personnel blinded to the selection of cream. After the procedure the patient was asked their level of discomfort with the laser follicle ablation on a 0-10 Likert pain scale. Follicle ablations were performed using a Cynosure Elite Plus laser, with Alexandrite for patients who were Fitzpatrick 1 or 2, and YAG (yttrium aluminum garnet) for those who were Fitzpatrick 3 to 5. RESULTS: Twenty-two patients were recruited to participate, 2 of whom did not return for their next clinic visit in a timely fashion, 1 secondary to a snowstorm and the other secondary to insurance issues, leaving 20 patients for analysis. The mean age was 20 years (range: 15 to 33), including 11 males (55 %). The mean pain score with LMX was 2.25 (SD 1.94) and placebo 1.78 (SD 1.15) (p = 0.18; Fig. 1). There were no noted complications. CONCLUSION: Application of topical anesthetic cream prior to laser follicle ablation adds significant time to a patient's clinic visit and does not appear to improve pain control when compared to placebo for gluteal laser follicle ablation for pilonidal disease.", "provenance": [ { "field": "population", "quote": "included patients presenting to the pilonidal care clinic for laser follicle ablation" }, { "field": "intervention", "quote": "topical anesthetic cream (LMX, 4 % topical lidocaine, Ferndale Laboratories Inc.)" }, { "field": "comparator", "quote": "or placebo and crossed over between study arms to serve as their own control" }, { "field": "primaryOutcome", "quote": "the patient was asked their level of discomfort with the laser follicle ablation on a 0-10 Likert pain scale" }, { "field": "result", "quote": "The mean pain score with LMX was 2.25 (SD 1.94) and placebo 1.78 (SD 1.15) (p = 0.18; Fig. 1)." }, { "field": "n", "quote": "leaving 20 patients for analysis" } ] }, { "id": "pmid:41094667", "pmid": "41094667", "doi": "10.1186/s12893-025-03222-y", "nctId": null, "pmcid": "PMC12529851", "title": "Future of pilonidal cyst surgery: a comparative review of traditional and laser techniques", "firstAuthor": "Jazi", "multipleAuthors": true, "journal": "BMC Surg", "year": 2025, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal cysts or sinus", "intervention": "laser-assisted surgery for pilonidal disease", "comparator": "traditional surgical techniques (excision, flap reconstructions)", "primaryOutcome": "effectiveness, recovery time, recurrence rates, complications, cosmetics, and costs", "result": "Laser techniques showed shorter hospital stays, less pain, lower recurrence, and healing rates up to 97%, but were less effective for severe cases and more costly", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a non-systematic comparative review of varied studies without pooled statistics, so it cannot reliably establish how well laser treatment works.", "directness": "direct", "limitations": "Abstract states additional research is needed to optimize laser procedures and establish long-term outcomes; laser may be less effective in severe or complicated cases.", "followUp": "", "plainFinding": "Faster recovery, fewer complications with laser", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41094667/", "sourceText": "Pilonidal disease is a common sacrococcygeal cyst or sinus that can significantly impact patients' quality of life, necessitating an analysis of evolving treatments to optimize patient outcomes. This review compares traditional and minimally invasive techniques focusing on laser ablation, in treating pilonidal cysts, focusing on each method's effectiveness, recovery time, recurrence rates, complications, cosmetics, and costs. We conducted a comprehensive assessment of literature exploring PubMed, Scopus, Web of Science, Google Scholar, and Embase for studies comparing traditional surgical techniques including traditional excision with open and closed healing, flap reconstructions, with minimally invasive procedures focusing on laser-assisted. Although traditional surgical techniques were practical, but they were associated with a relatively high risk of wound complications, recurrence, extended healing periods, and poor cosmetics. Laser techniques showed promising results in reducing hospital stays (for at most 3 h vs. days), postoperative pain, and recurrence rates, with healing rates up to 97%. However, laser methods may be less effective in severe or complicated cases, and they have higher costs. Laser-assisted techniques offer a less invasive option compared to traditional surgery, with greater patient fulfillment. However, additional research is needed to optimize laser procedures, especially in complex cases, and to establish long-term outcomes. For simpler pilonidal cysts, laser treatments are a promising option that could eventually replace traditional surgery as the standard of care.", "provenance": [ { "field": "population", "quote": "Pilonidal disease is a common sacrococcygeal cyst or sinus" }, { "field": "intervention", "quote": "minimally invasive procedures focusing on laser-assisted" }, { "field": "comparator", "quote": "traditional surgical techniques including traditional excision with open and closed healing, flap reconstructions" }, { "field": "primaryOutcome", "quote": "focusing on each method's effectiveness, recovery time, recurrence rates, complications, cosmetics, and costs" }, { "field": "result", "quote": "Laser techniques showed promising results in reducing hospital stays (for at most 3 h vs. days), postoperative pain, and recurrence rates, with healing rates up to 97%. However, laser methods may be less effective in severe or complicated cases, and they have higher costs." } ] }, { "id": "pmid:41078023", "pmid": "41078023", "doi": "10.1002/lsm.70071", "nctId": null, "pmcid": "PMC12689488", "title": "International Society of Laser Proctology Position Paper on SiLaC and EPSiT/SiLaC in the Management of Pilonidal Sinus Disease", "firstAuthor": "Ouali", "multipleAuthors": true, "journal": "Lasers Surg Med", "year": 2025, "design": "guideline", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus disease", "intervention": "laser treatment (SiLaC and EPSiT/SiLaC) for pilonidal sinus", "comparator": "no direct comparator; consensus on technique variations", "primaryOutcome": "standardizing treatment technique to improve outcomes", "result": "Experts agreed on 10 statements to standardize the laser procedure, based on limited evidence and expert opinion", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is an expert consensus/position paper based on limited evidence rather than a study measuring patient outcomes.", "directness": "indirect", "limitations": "Based largely on expert opinion rather than controlled trial data; abstract states evidence is limited.", "followUp": "", "plainFinding": "Expert opinion, not outcome data.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41078023/", "sourceText": "OBJECTIVES: Minimally invasive treatment of pilonidal sinus disease (PSD) via sinus tract laser closure (SiLaC) and endoscopic pilonidal sinus treatment (EPSiT) is being increasingly employed to manage PSD. Despite its wide adoption amongst colorectal surgeons in many nations, there still exists a wide heterogeneity in surgical technique. The International Society of Laser Proctology (ISoLP) was created by experts in laser proctology has the goal of improving laser-based interventions in coloproctology with the aim of improving patient care in this specialized area. METHODS: This position paper is based on the limited evidence from available literature and largely on the expert opinion of ISoLP members with extended expertise in SiLaC and EPSiT. RESULTS: ISoLP experts in SiLaC and EPSiT procedures have suggested 10 statements to aid in homogenizing the SiLaC procedure alone and in combination with EPSiT, with the goal of improving treatment outcomes. CONCLUSION: The 10 ISoLP position statements have a potential of shaping and homogenizing laser-assisted management of PSD.", "provenance": [ { "field": "population", "quote": "Minimally invasive treatment of pilonidal sinus disease (PSD)" }, { "field": "intervention", "quote": "sinus tract laser closure (SiLaC) and endoscopic pilonidal sinus treatment (EPSiT)" }, { "field": "comparator", "quote": "there still exists a wide heterogeneity in surgical technique" }, { "field": "primaryOutcome", "quote": "improving treatment outcomes" }, { "field": "result", "quote": "ISoLP experts in SiLaC and EPSiT procedures have suggested 10 statements to aid in homogenizing the SiLaC procedure alone and in combination with EPSiT, with the goal of improving treatment outcomes." }, { "field": "qualityWhy", "quote": "This position paper is based on the limited evidence from available literature and largely on the expert opinion of ISoLP members" } ] }, { "id": "pmid:41019483", "pmid": "41019483", "doi": "10.3892/etm.2025.12969", "nctId": null, "pmcid": "PMC12464478", "title": "Comparative analysis of treatment modalities and contributing factors in recurrent pilonidal sinus disease", "firstAuthor": "Lagus", "multipleAuthors": true, "journal": "Exp Ther Med", "year": 2025, "design": "retrospective", "n": 63, "nField": "reported", "population": "patients with recurrent pilonidal sinus disease", "intervention": "laser treatment as primary or re-operative surgery", "comparator": "excision with direct closure or flap reconstruction surgery", "primaryOutcome": "need for re-operation after primary surgery", "result": "about 1 in 5 patients needed re-operation across all groups, but recurrence or residual disease was a more common reason for re-operation after laser treatment compared with direct closure or flap surgery", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a small retrospective study with only 13 patients in the laser group, making the findings unreliable for drawing firm conclusions.", "directness": "indirect", "limitations": "Retrospective design, small group sizes (especially laser group n=13), and authors state long-term outcomes are needed to confirm findings.", "followUp": "18.3 months", "plainFinding": "Similar reoperation rates, but more recurrences after laser.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41019483/", "sourceText": "Pilonidal sinus disease (PSD) is a common and frequently recurring condition affecting young men. Despite the frequent recurrence of PSD, there is a lack of published literature addressing the management of recurrent disease. In the present retrospective study, data from 63 patients with recurrent pilonidal sinuses treated at the Plastic Surgery Department of Kuopio University Hospital (Kuopio, Finland) between 2010 and 2021 were analyzed. Patients were categorized into three groups based on the primary operation: Laser treatment (n=13), excision combined with direct closure (n=32) and flap reconstruction (n=18). The patient characteristics, complications, re-operative methods and follow-up times of these groups were compared. The minimum follow-up time was 18.3 months. Furthermore, ~1 in 5 patients required re-operation after the primary operation: 18.8% after laser treatment, 20.5% after direct closure and 19.2% after flap reconstruction. Residual disease or recurrence was more common as a reason for re-operation in the laser group compared with the other groups (direct closure group, P=0.003; flap group, P=0.010). Direct closure was the most common method for re-operation after primary direct closure and flap reconstruction (56.3 and 55.6%, respectively). However, patients treated primarily with laser were most likely re-operated with laser (61.5%), with only 15.4% operated using secondary direct closure and 23.1% with secondary flap reconstruction. In conclusion, the risk of recurrent PSD remains significant, yet most patients typically required only one re-operation. Laser treatment was a promising approach for both primary and recurrent cases. However, long-term outcomes are necessary to confirm this.", "provenance": [ { "field": "n", "quote": "data from 63 patients with recurrent pilonidal sinuses treated at the Plastic Surgery Department of Kuopio University Hospital" }, { "field": "population", "quote": "63 patients with recurrent pilonidal sinuses treated at the Plastic Surgery Department of Kuopio University Hospital (Kuopio, Finland) between 2010 and 2021" }, { "field": "intervention", "quote": "Laser treatment (n=13)" }, { "field": "comparator", "quote": "excision combined with direct closure (n=32) and flap reconstruction (n=18)" }, { "field": "primaryOutcome", "quote": "~1 in 5 patients required re-operation after the primary operation" }, { "field": "result", "quote": "Residual disease or recurrence was more common as a reason for re-operation in the laser group compared with the other groups (direct closure group, P=0.003; flap group, P=0.010)." }, { "field": "followUp", "quote": "The minimum follow-up time was 18.3 months." } ] }, { "id": "pmid:40769774", "pmid": "40769774", "doi": "10.1002/wjs.70028", "nctId": null, "pmcid": "PMC12435601", "title": "Minimal Invasive Surgical Treatment in Primary Sacrococcygeal Pilonidal Sinus Disease: Phenolization of the Sinus Tract Versus Sinus Laser Assisted Closure; Long-Term Follow-Up of a Comparative Cohort Study", "firstAuthor": "de Kort", "multipleAuthors": true, "journal": "World J Surg", "year": 2025, "design": "retrospective", "n": 72, "nField": "reported", "population": "patients with primary chronic sacrococcygeal pilonidal sinus disease", "intervention": "sinus laser-assisted closure (SiLaC)", "comparator": "phenolization of the sinus tract", "primaryOutcome": "need for additional surgery and quality of life/symptoms", "result": "Phenolization had fewer patients needing additional surgery (19.4% vs 30.6%) and slightly better pain and general health scores, but overall quality of life measures did not differ significantly; no clear superiority of either technique", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective, matched comparative cohort (not randomized) with modest patient numbers from two hospitals, so differences could be due to other factors.", "directness": "direct", "limitations": "Not randomized; retrospective record review; small sample size; matched but not controlled for all confounders.", "followUp": "47 months", "plainFinding": "No clear winner between treatments.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40769774/", "sourceText": "BACKGROUND: No consensus has been reached on the preferred minimally invasive technique for treating primary, chronic sacrococcygeal pilonidal sinus disease. This study will compare two extensively used minimally invasive techniques: phenolization of the sinus tract and sinus laser-assisted closure. METHODS: A comparative cohort study was conducted in two hospitals. Patients were matched on sex, age, number of sinus pits at surgery, and duration of follow-up. Patient records were examined for additional surgeries, and quality of life and symptoms were assessed with a questionnaire. RESULTS: After a mean follow-up of 47 months, seven patients (19.4%) in the phenolization group (n = 36) required additional surgery and 11 patients (30.6%) in the SiLaC group (n = 36) underwent additional surgery. Pain as a symptom at the natal cleft was significantly lower in the phenolization group, though not clinically relevant. The question regarding general health compared to preoperatively was reported to be significantly better in the phenolization group. However, other quality of life outcomes, such as the VAS score and the SF-36, did not differ significantly between phenolization and SiLaC. CONCLUSION: Both phenolization and sinus laser-assisted closure appear to be feasible for patients with primary SPSD, with no clear superiority of either technique.", "provenance": [ { "field": "population", "quote": "primary, chronic sacrococcygeal pilonidal sinus disease" }, { "field": "intervention", "quote": "sinus laser-assisted closure" }, { "field": "comparator", "quote": "phenolization of the sinus tract" }, { "field": "n", "quote": "phenolization group (n = 36)" }, { "field": "n", "quote": "SiLaC group (n = 36)" }, { "field": "primaryOutcome", "quote": "Patient records were examined for additional surgeries, and quality of life and symptoms were assessed with a questionnaire." }, { "field": "result", "quote": "seven patients (19.4%) in the phenolization group (n = 36) required additional surgery and 11 patients (30.6%) in the SiLaC group (n = 36) underwent additional surgery" }, { "field": "result", "quote": "Both phenolization and sinus laser-assisted closure appear to be feasible for patients with primary SPSD, with no clear superiority of either technique." }, { "field": "followUp", "quote": "After a mean follow-up of 47 months" } ] }, { "id": "pmid:40736584", "pmid": "40736584", "doi": "10.1007/s10151-025-03191-7", "nctId": null, "pmcid": "PMC12310914", "title": "The application of EPSiT in pilonidal sinus disease: an international Delphi consensus study endorsed by the Association of Laparoscopic Surgeons of Great Britain and Ireland (ALSGBI)", "firstAuthor": "Sekhon Inderjit Singh", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2025, "design": "guideline", "n": 20, "nField": "reported", "population": "patients with pilonidal sinus disease (primary and recurrent, adult and paediatric)", "intervention": "Endoscopic pilonidal sinus treatment (EPSiT)", "comparator": "no comparator, expert consensus opinions gathered", "primaryOutcome": "expert agreement on statements regarding EPSiT application and protocols", "result": "Experts reached consensus on 28 statements about EPSiT use, including recommending laser epilation and re-EPSiT for failures, but no clinical outcome data reported", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is an expert opinion consensus study, not a clinical trial, so it cannot show whether the treatment actually works.", "directness": "indirect", "limitations": "Delphi consensus of expert opinion only, no patient outcome data, small panel of 20 experts", "followUp": "", "plainFinding": "Expert opinions on technique, not effectiveness.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40736584/", "sourceText": "BACKGROUND: Endoscopic pilonidal sinus treatment (EPSiT) is a novel, minimally invasive surgical technique that has shown promise in the treatment of pilonidal sinus disease. Despite the apparent benefits and call for increased use, widespread uptake has been slow. This study aims to gather and understand expert international opinions on EPSiT and develop recommendations for its application in the surgical community. METHODS: Expert international panellists were identified and recruited to participate. A three-round modified Delphi consensus consisting of 43 questions regarding the application of EPSiT was posed. A combination of a five-point Likert scale, binary 'yes/no' scale and multiple-choice questions was used. The consensus threshold was set at 70% agreement. When consensus was not achieved or further insight was required, statement questions were posed. The study has been performed in accordance with ACcurate COnsensus Reporting Document (ACCORD) explanation and elaboration guidelines. RESULTS: Twenty experts from six countries participated in all rounds, with a 100% response rate. Our experts agreed on 28 statements including: the absence of absolute contraindications to EPSiT; administering intravenous induction antibiotics routinely but not post-operative oral antibiotics; recommending laser epilation; offering re-EPSiT to the informed patient after first and second procedure failures; and that EPSiT should be incorporated into surgical training programmes. CONCLUSIONS: This is the first study to provide an international expert consensus on the specific application of EPSiT in primary and recurrent adult and paediatric patients with pilonidal sinus disease. The findings of this study contribute to the development of protocols for EPSiT in pilonidal sinus disease management, addressing key areas of consensus and controversy and promoting procedure uptake.", "provenance": [ { "field": "n", "quote": "Twenty experts from six countries participated in all rounds" }, { "field": "population", "quote": "primary and recurrent adult and paediatric patients with pilonidal sinus disease" }, { "field": "intervention", "quote": "Endoscopic pilonidal sinus treatment (EPSiT) is a novel, minimally invasive surgical technique" }, { "field": "comparator", "quote": "Expert international panellists were identified and recruited to participate." }, { "field": "primaryOutcome", "quote": "gather and understand expert international opinions on EPSiT and develop recommendations for its application" }, { "field": "result", "quote": "Our experts agreed on 28 statements including: the absence of absolute contraindications to EPSiT; administering intravenous induction antibiotics routinely but not post-operative oral antibiotics; recommending laser epilation; offering re-EPSiT to the informed patient after first and second procedure failures" } ] }, { "id": "pmid:40522552", "pmid": "40522552", "doi": "10.1007/s10103-025-04525-5", "nctId": null, "pmcid": "PMC12170725", "title": "Evaluation of laser ablation for recurrent pilonidal sinus disease: treatment success, recurrence rates, and patient outcomes", "firstAuthor": "Emral", "multipleAuthors": true, "journal": "Lasers Med Sci", "year": 2025, "design": "retrospective", "n": 37, "nField": "reported", "population": "patients with recurrent pilonidal sinus disease", "intervention": "laser ablation", "comparator": "none (single-arm, before/after outcomes)", "primaryOutcome": "complete healing without recurrence", "result": "70.3% of patients healed completely without recurrence, 21.6% had recurrence, 13.5% had superficial infections", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This was a small retrospective study of one treatment with no comparison group, so it cannot show if laser worked better than other options.", "directness": "direct", "limitations": "Retrospective design, no control group, small sample size", "followUp": "9.6 months", "plainFinding": "Most healed, some recurred", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40522552/", "sourceText": "PURPOSE: Pilonidal sinus disease (PD) is a chronic, recurrent inflammatory condition primarily affecting the sacrococcygeal region, often resulting in discomfort, abscess formation, and recurrent disease. Various surgical interventions, including laser ablation, have been employed to treat recurrent PD. This study evaluates the efficacy of laser ablation in patients with recurrent PD, focusing on treatment success, recurrence rates, complications, and recovery outcomes. METHODS: A retrospective analysis of 37 patients with recurrent pilonidal sinus disease treated with laser ablation between January 2022 and January 2025 was conducted. Preoperative data, postoperative complications, healing time, Visual Analog Scale values, and return to normal activities were collected. RESULTS: The results showed that 70.3% of patients achieved complete healing without recurrence, while 21.6% experienced recurrence within a mean follow-up of 9.6 months. Five patients (13.5%) developed superficial infections, which were managed with local dressing. The median time for wound healing was 35 days, and patients returned to normal activities in an median of 1 day. Persistent disease was observed in 8 patients (21.6%), of whom 5 patients (62.5%) achieved full epithelialization after retreatment with laser ablation. CONCLUSION: The ease of application, avoidance of hospitalization, minimal postoperative care, and rapid return to daily activities make laser treatment a safe and effective therapeutic option for patients with recurrent pilonidal disease, supported by favorable outcomes and low morbidity.", "provenance": [ { "field": "n", "quote": "A retrospective analysis of 37 patients with recurrent pilonidal sinus disease" }, { "field": "population", "quote": "patients with recurrent pilonidal sinus disease" }, { "field": "intervention", "quote": "treated with laser ablation between January 2022 and January 2025" }, { "field": "comparator", "quote": "A retrospective analysis of 37 patients with recurrent pilonidal sinus disease treated with laser ablation" }, { "field": "primaryOutcome", "quote": "treatment success, recurrence rates, complications, and recovery outcomes" }, { "field": "result", "quote": "70.3% of patients achieved complete healing without recurrence, while 21.6% experienced recurrence within a mean follow-up of 9.6 months. Five patients (13.5%) developed superficial infections" }, { "field": "followUp", "quote": "mean follow-up of 9.6 months" } ] }, { "id": "pmid:40464115", "pmid": "40464115", "doi": "10.1111/jocd.70231", "nctId": null, "pmcid": "PMC12135030", "title": "The Versatile Applications of Triple-Wavelength Diode Laser (810, 940, and 1060 nm) in Aesthetic Treatments, Follicular Disorders, and Chronic Inflammatory Conditions in the Asian Population: Case Report Collection", "firstAuthor": "Pall", "multipleAuthors": false, "journal": "J Cosmet Dermatol", "year": 2025, "design": "retrospective", "n": null, "nField": "not-reported", "population": "adults with skin type IV with facial hirsutism and follicular disorders, including trichostasis spinulosa, pilonidal sinus disease, and hidradenitis suppurativa", "intervention": "high-power triple-wavelength diode laser (810, 940, and 1060 nm)", "comparator": "none described; before-and-after assessment only", "primaryOutcome": "hair count reduction and overall aesthetic improvement (GAIS score)", "result": "overall hair reduction of 82.9% and a mean GAIS improvement of 3.4 out of 4 across all treated conditions combined, with no outcome reported specifically for pilonidal sinus disease", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a small retrospective case collection mixing several different skin conditions with no control group, and it does not separate out results for pilonidal sinus disease.", "directness": "indirect", "limitations": "Retrospective design, no comparator group, results pooled across different conditions (hirsutism, trichostasis spinulosa, pilonidal sinus disease, hidradenitis suppurativa) without separate outcomes for pilonidal cysts, and sample size not reported.", "followUp": "", "plainFinding": "No separate result reported for pilonidal cysts.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40464115/", "sourceText": "BACKGROUND: Single-wavelength lasers (755 or 810 nm) are widely used to remove unwanted hair. Recently, combined-wavelength diode lasers have been introduced to improve the safety of darker skin types, owing to their varying absorption spectra and penetration depths. However, their application beyond hair removal remains unclear. AIMS: This study aimed to evaluate the efficacy of a high-power triple-wavelength diode laser (810, 940, and 1060 nm) in treating hirsutism, inflammatory follicular disorders, and aesthetic concerns such as hairline enhancement in darker skin types. PATIENTS/METHODS: This retrospective study was conducted at the Escallent Institute of Lasers & Aesthetic Medicine (EILAM), Gurugam, India, using a Primelase device with a triple-wavelength diode laser. The study involved adults with skin type IV who presented with facial hirsutism and follicular disorders, including trichostasis spinulosa, pilonidal sinus disease, and hidradenitis suppurativa. Efficacy was assessed using hair counting and the Global Aesthetic Improvement Scale (GAIS), whereas safety was evaluated based on reported adverse effects, such as pain, erythema, and edema. RESULTS: The GAIS scores indicated a mean improvement of 3.4 ± 0.4 out of 4, representing a 50%-75% improvement. Hair counting revealed a statistically significant hair reduction of 82.9% ± 15.4%, with reductions ranging from 56% to 100%. No adverse events were observed. CONCLUSION: The high-power triple-wavelength diode laser demonstrated both efficacy and safety in treating facial hirsutism and other follicular disorders as well as aesthetic concerns such as hairline enhancement, particularly in darker skin tones.", "provenance": [ { "field": "design", "quote": "This retrospective study was conducted at the Escallent Institute of Lasers & Aesthetic Medicine (EILAM), Gurugam, India, using a Primelase device with a triple-wavelength diode laser." }, { "field": "population", "quote": "adults with skin type IV who presented with facial hirsutism and follicular disorders, including trichostasis spinulosa, pilonidal sinus disease, and hidradenitis suppurativa" }, { "field": "intervention", "quote": "high-power triple-wavelength diode laser (810, 940, and 1060 nm)" }, { "field": "comparator", "quote": "Efficacy was assessed using hair counting and the Global Aesthetic Improvement Scale (GAIS), whereas safety was evaluated based on reported adverse effects, such as pain, erythema, and edema." }, { "field": "primaryOutcome", "quote": "Efficacy was assessed using hair counting and the Global Aesthetic Improvement Scale (GAIS)" }, { "field": "result", "quote": "The GAIS scores indicated a mean improvement of 3.4 ± 0.4 out of 4, representing a 50%-75% improvement. Hair counting revealed a statistically significant hair reduction of 82.9% ± 15.4%, with reductions ranging from 56% to 100%." } ] }, { "id": "pmid:40364084", "pmid": "40364084", "doi": "10.3390/jcm14093052", "nctId": null, "pmcid": "PMC12072559", "title": "The Efficacy of Punch Biopsy and Diode Laser Combination in the Treatment of Pilonidal Sinus: A Comparative Study Across Different Patient Groups", "firstAuthor": "Evirgen", "multipleAuthors": true, "journal": "J Clin Med", "year": 2025, "design": "prospective-cohort", "n": 187, "nField": "reported", "population": "patients with pilonidal sinus disease, divided into simple and complicated cases", "intervention": "pit excision with punch biopsy needle combined with 1470 nm diode laser closure", "comparator": "simple disease group versus complicated disease group (no prior abscess vs history of abscess drainage)", "primaryOutcome": "operative time, postoperative pain, wound-healing duration, recurrence rate, and return-to-work time", "result": "Simple cases had lower operative time, pain, and healing duration, with 3.7% recurrence versus 14.1% in complicated cases", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a single-group prospective study without a comparator treatment or randomization, so it cannot show whether laser is better than other options.", "directness": "direct", "limitations": "No control group receiving a different treatment; abstract does not report blinding or long-term follow-up duration beyond immediate postoperative period.", "followUp": "", "plainFinding": "Fewer complications in simple cases.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40364084/", "sourceText": "Background: This study aims to evaluate the efficacy and safety of a minimally invasive technique (pit excision with a punch biopsy needle) using a 1470 nm diode laser in the treatment of pilonidal sinus disease. Methods: A prospective study conducted included 187 patients who underwent laser treatment for pilonidal sinus. Patients were divided into two groups based on the severity of the disease: Group 1 (simple group) included patients who had no prior abscess formation and had one or two sinus openings, while Group 2 (complicated group) comprised patients with a history of abscess drainage and more two extensive sinus openings. The surgical procedure was performed under local anesthesia. The sinus openings were excised using a punch biopsy needle and subsequently closed with a diode laser probe. Patients were followed up at regular intervals during the postoperative period. Results: The findings revealed that the operative time (12.22 ± 1.72 min), postoperative pain scores and wound-healing duration were significantly lower in the simple group compared to the complicated group (p < 0.001). The recurrence rates were 3.7% in the simple group and 14.1% in the complicated group. The return-to-work time was 1.06 ± 0.32 days in the simple group and 1.32 ± 0.90 days in the complicated group. Conclusions: In conclusion, the combination of punch biopsy and diode laser is considered a safe and effective method, particularly for simple pilonidal sinus cases, due to its low complication rates, short recovery time, and early return-to-work advantages. However, more advanced treatment approaches are required for complicated cases.", "provenance": [ { "field": "n", "quote": "A prospective study conducted included 187 patients who underwent laser treatment for pilonidal sinus." }, { "field": "population", "quote": "Patients were divided into two groups based on the severity of the disease: Group 1 (simple group) included patients who had no prior abscess formation and had one or two sinus openings, while Group 2 (complicated group) comprised patients with a history of abscess drainage and more two extensive sinus openings." }, { "field": "intervention", "quote": "The sinus openings were excised using a punch biopsy needle and subsequently closed with a diode laser probe." }, { "field": "comparator", "quote": "Patients were divided into two groups based on the severity of the disease: Group 1 (simple group) included patients who had no prior abscess formation and had one or two sinus openings, while Group 2 (complicated group) comprised patients with a history of abscess drainage and more two extensive sinus openings." }, { "field": "primaryOutcome", "quote": "operative time (12.22 ± 1.72 min), postoperative pain scores and wound-healing duration were significantly lower in the simple group compared to the complicated group (p < 0.001)" }, { "field": "result", "quote": "The recurrence rates were 3.7% in the simple group and 14.1% in the complicated group." } ] }, { "id": "pmid:40352310", "pmid": "40352310", "doi": "10.3389/fsurg.2025.1587467", "nctId": null, "pmcid": "PMC12062001", "title": "SiLaC® with EPSiT®: early outcomes of laser-endoscopic therapy for pilonidal sinus", "firstAuthor": "Ouali", "multipleAuthors": false, "journal": "Front Surg", "year": 2025, "design": "retrospective", "n": 83, "nField": "reported", "population": "young adults with pilonidal sinus disease, aged 15-50", "intervention": "combined laser ablation (SiLaC) and endoscopic treatment (EPSiT) for pilonidal sinus", "comparator": "none (no comparison group)", "primaryOutcome": "pain, healing time, and recurrence after treatment", "result": "low pain, fast healing, and 3.6% recurrence at 6 months", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective single-center study with no comparison group, so it cannot show the treatment works better than alternatives.", "directness": "direct", "limitations": "Retrospective design, single center, no control group, relatively short follow-up (6 months, with only a subset to 1 year).", "followUp": "at least 6 months of follow-up; a subset was followed up to 1 year", "plainFinding": "Low pain, fast healing, few recurrences.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40352310/", "sourceText": "BACKGROUND: Pilonidal sinus disease (PSD) commonly affects young adults and often requires repeated interventions with prolonged healing times. We evaluated a combined approach using Sinus Laser Ablation of the Cyst (SiLaC®) and Endoscopic Pilonidal Sinus Treatment (EPSiT®) to investigate postoperative pain, healing time, and recurrence. METHODS: This retrospective, single-center study included 83 patients (aged 15-50) treated from January 2021 to December 2023 at Proctolaser Clinic, Tunisia. Under local, regional, or general anesthesia, patients underwent endoscopic debridement (EPSiT®) followed by diode laser ablation (SiLaC®) of sinus tracts. Data on operative time, Visual Analogue Scale (VAS) pain score, healing time to complete epithelialization, recurrence, and time to return to work were collected. All patients had at least 6 months of follow-up; a subset was followed up to 1 year. RESULTS: The mean operative time was 25 ± 5.4 min. Mean VAS pain score at 24 h was 1.2 ± 0.6, and 92.3% of patients resumed work or normal activities within 24 h. Mean healing time was 17.3 days, with 95% achieving complete epithelialization by 3 weeks. The overall recurrence rate at 6 months was 3.6% (3/83). Two recurrences (3.3%) occurred in patients with primary PSD, and one recurrence (4.3%) occurred in a patient with recurrent PSD. Minor infections occurred in 1.2% (1/83) of patients and resolved with oral antibiotics. Aesthetic satisfaction was high; 88% rated outcomes \"excellent.\" CONCLUSIONS: Combining SiLaC® with EPSiT® for pilonidal sinus disease appears safe and effective, featuring minimal pain, rapid return to daily activities, low recurrence, and excellent cosmetic results. A longer-term, multicenter approach is recommended to confirm durability and cost-effectiveness.", "provenance": [ { "field": "n", "quote": "This retrospective, single-center study included 83 patients (aged 15-50)" }, { "field": "population", "quote": "Pilonidal sinus disease (PSD) commonly affects young adults" }, { "field": "intervention", "quote": "a combined approach using Sinus Laser Ablation of the Cyst (SiLaC®) and Endoscopic Pilonidal Sinus Treatment (EPSiT®)" }, { "field": "comparator", "quote": "This retrospective, single-center study included 83 patients" }, { "field": "primaryOutcome", "quote": "Data on operative time, Visual Analogue Scale (VAS) pain score, healing time to complete epithelialization, recurrence, and time to return to work were collected." }, { "field": "result", "quote": "Mean VAS pain score at 24 h was 1.2 ± 0.6, and 92.3% of patients resumed work or normal activities within 24 h. Mean healing time was 17.3 days, with 95% achieving complete epithelialization by 3 weeks. The overall recurrence rate at 6 months was 3.6% (3/83)." }, { "field": "followUp", "quote": "All patients had at least 6 months of follow-up; a subset was followed up to 1 year." } ] }, { "id": "pmid:40108765", "pmid": "40108765", "doi": "10.1002/lsm.70008", "nctId": null, "pmcid": null, "title": "A Comparitive Study Between Early Outcomes of Laser and Lay-Open Technique in Management of Simple Pilonidal Sinus", "firstAuthor": "El Deen", "multipleAuthors": true, "journal": "Lasers Surg Med", "year": 2025, "design": "rct", "n": 40, "nField": "reported", "population": "patients with simple/chronic pilonidal sinus disease", "intervention": "laser therapy (SiLaT, diode laser)", "comparator": "lay-open technique (sinotomy)", "primaryOutcome": "postoperative outcomes including operative time, hospital stay, pain scores, healing time, complications, and recurrence rates", "result": "Laser therapy had shorter operative time, shorter hospital stay, lower pain scores, and faster wound healing than lay-open surgery, with similar recurrence and infection rates", "resultDirection": "mixed", "quality": "low", "qualityWhy": "Small trial of only 40 patients with short-term follow-up, so results may not be reliable or generalizable long-term.", "directness": "direct", "limitations": "Small sample size; only early postoperative outcomes assessed; authors call for long-term studies.", "followUp": "", "plainFinding": "Faster recovery, less pain with laser", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40108765/", "sourceText": "BACKGROUND: Pilonidal sinus (PS) predominantly impacts adolescent and young adult males. This condition may be asymptomatically or escalate to painful acute abscesses and recurrent discharge. OBJECTIVE: To evaluate the early postoperative outcomes of laser therapy compared to the lay-open technique in the treatment of chronic pilonidal sinus disease. METHODS: Prospective randomized comparative study including 40 patients, divided into two equal groups: (a) The SiLaT group: PS treated with diode laser therapy (SiLaT) and (b) the lay-open group: PS treated with lay-open (sinotomy). Postoperative outcomes such as operative time, hospital stay, pain scores, healing time, complications, and recurrence rates were analyzed. RESULTS: Operative time was significantly shorter in the SiLaT group (18.4 ± 2.1 min vs. 26.2 ± 3.7 min, p = 0.022). Hospital stay was shorter in the SiLaT group (6.60 ± 1.47 h vs. 15.10 ± 5.52 h, p < 0.001). Pain scores were lower in the SiLaT group (2.30 ± 0.92 vs. 4.80 ± 1.01, p < 0.001). Wound healing was significantly faster in the SiLaT group (10.1 ± 2.7 days vs. 34.1 ± 15.1 days, p < 0.0001). Recurrence rates (p = 0.998) and surgical site infection (p = 1.00) were comparable among both groups. CONCLUSION: Sinus laser therapy (SiLaT) demonstrated superior early outcomes, including faster recovery, reduced pain, and fewer complications with earlier resumption of daily activities compared to the lay-open technique. However, recurrence rates remain similar, necessitating long-term studies to evaluate its effectiveness as a first-line treatment. These findings support the use of SiLaT as a day-case surgical procedure, for treating simple PS disease, particularly in young active patients seeking rapid recovery with minimal morbidity.", "provenance": [ { "field": "n", "quote": "Prospective randomized comparative study including 40 patients, divided into two equal groups" }, { "field": "population", "quote": "evaluate the early postoperative outcomes of laser therapy compared to the lay-open technique in the treatment of chronic pilonidal sinus disease" }, { "field": "intervention", "quote": "PS treated with diode laser therapy (SiLaT)" }, { "field": "comparator", "quote": "the lay-open group: PS treated with lay-open (sinotomy)" }, { "field": "primaryOutcome", "quote": "Postoperative outcomes such as operative time, hospital stay, pain scores, healing time, complications, and recurrence rates were analyzed." }, { "field": "result", "quote": "Operative time was significantly shorter in the SiLaT group (18.4 ± 2.1 min vs. 26.2 ± 3.7 min, p = 0.022). Hospital stay was shorter in the SiLaT group (6.60 ± 1.47 h vs. 15.10 ± 5.52 h, p < 0.001). Pain scores were lower in the SiLaT group (2.30 ± 0.92 vs. 4.80 ± 1.01, p < 0.001). Wound healing was significantly faster in the SiLaT group (10.1 ± 2.7 days vs. 34.1 ± 15.1 days, p < 0.0001). Recurrence rates (p = 0.998) and surgical site infection (p = 1.00) were comparable among both groups." } ] }, { "id": "pmid:40100423", "pmid": "40100423", "doi": "10.1007/s10103-025-04409-8", "nctId": null, "pmcid": "PMC11920000", "title": "Is it beneficial to add laser ablation to curettage in the treatment of pilonidal sinus disease?", "firstAuthor": "Demir", "multipleAuthors": true, "journal": "Lasers Med Sci", "year": 2025, "design": "rct", "n": 80, "nField": "reported", "population": "patients with pilonidal sinus disease", "intervention": "laser ablation combined with sinus curettage", "comparator": "sinus curettage alone", "primaryOutcome": "postoperative complications, wound healing, and recurrence", "result": "no significant difference between groups in pain, discharge, bleeding, wound healing problems, or recurrence at 6 months", "resultDirection": "no-benefit", "quality": "moderate", "qualityWhy": "it was a randomized trial but small, with no significant differences found on any outcome, limiting confidence in the findings.", "directness": "direct", "limitations": "small sample size per group (40 each) and only non-significant trends reported", "followUp": "6 months", "plainFinding": "No added benefit over curettage alone.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40100423/", "sourceText": "AIM: This study aimed to compare laser application with sinus curettage against only sinus curettage in the treatment of pilonidal sinus disease (PSD) in terms of postoperative complications, wound healing, and recurrence. Additionally, we aimed to investigate factors associated with wound healing and recurrence after PSD surgery. PATIENTS AND METHODS: This study included patients diagnosed with PSD between February 2019, and September 2022. The patients were randomly assigned to either the laser + curettage (L/C; n = 40) group or the curettage-only (C; n = 40) group. The following data were collected: demographic and anthropometric information, smoking status, comorbidities, number of PSD-related orifices, complicated or uncomplicated disease, prior recurrence, postoperative findings, wound healing problems within 30 days postoperatively, and recurrence within 6 months postoperatively. RESULTS: The L/C and C groups were similar in terms of age and sex distribution. The groups had similar results for postoperative pain, discharge, bleeding, wound healing problems at 30 days, and recurrence at 6 months. Multivariable logistic regression revealed that, high weight and higher orifice count were independently associated with wound healing problems. Additionally, high weight, higher orifice count and prior recurrence were independently associated with recurrence. CONCLUSION: Combined curettage and laser therapy showed non-significant but broad benefits over curettage alone, but statistical significance was not achieved in any of the adverse findings, as well as wound healing and recurrence. Higher body weight and higher orifice count were associated with both poor wound healing and recurrence, while prior recurrence was another factor associated with recurrence at 6 months.", "provenance": [ { "field": "n", "quote": "laser + curettage (L/C; n = 40) group or the curettage-only (C; n = 40) group" }, { "field": "population", "quote": "patients diagnosed with PSD" }, { "field": "intervention", "quote": "laser application with sinus curettage" }, { "field": "comparator", "quote": "only sinus curettage" }, { "field": "primaryOutcome", "quote": "postoperative complications, wound healing, and recurrence" }, { "field": "result", "quote": "The groups had similar results for postoperative pain, discharge, bleeding, wound healing problems at 30 days, and recurrence at 6 months." }, { "field": "followUp", "quote": "recurrence within 6 months postoperatively" } ] }, { "id": "pmid:40086161", "pmid": "40086161", "doi": "10.1016/j.jpedsurg.2025.162267", "nctId": null, "pmcid": null, "title": "Gender Differences in Adolescent Pilonidal Disease", "firstAuthor": "Stoeckel", "multipleAuthors": true, "journal": "J Pediatr Surg", "year": 2025, "design": "retrospective", "n": 1356, "nField": "reported", "population": "adolescents with pilonidal disease, by gender", "intervention": "laser follicle ablation (among other clinic treatments)", "comparator": "other treatments such as pit picking and incision and drainage, compared between female and male patients", "primaryOutcome": "gender differences in pilonidal disease severity, quality of life impact, and treatment tolerance", "result": "similar rates of laser follicle ablation were used in both genders, but no outcome or effectiveness data for laser treatment itself were reported", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a retrospective cohort study comparing genders, not designed to test whether laser treatment works, and it reports only usage rates, not outcomes of laser therapy.", "directness": "indirect", "limitations": "Retrospective design; study focuses on gender differences rather than evaluating laser treatment efficacy; no outcome data for laser ablation given.", "followUp": "", "plainFinding": "No efficacy data on laser.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40086161/", "sourceText": "BACKGROUND: Pilonidal disease is a common, disruptive condition in adolescents. We studied the effects of pilonidal disease on adolescents by gender. STUDY DESIGN: Prospectively collected data on demographics, mental health comorbidities, disease severity, hirsutism, disease-related quality of life impact, interventions, and outcomes were retrieved from a Pilonidal Care Clinic REDCap database and were analyzed by gender. RESULTS: Of 1356 patients with pilonidal disease, 562 (41 %) were female and 794 male. Average age at disease onset was 14.8 years for females and 16.9 years for males (p-value <0.001). The incidence of mental health comorbidities was similar in females compared to males (17 % vs 16 %; p-value = 0.268) but females had a higher incidence of diagnosed anxiety (15 % vs 10 %; p-value = 0.005). Females were less likely to be hirsute than males (32 % vs 79 %; p-value <0.001), and were more likely to have fine hair in their gluteal crease (51 % vs 5 %; p-value <0.001). Females presented with lower disease severity than males (mild: 68 % vs 47 %, moderate: 22 % vs 33 %, and severe: 3 % vs 10 %; p-value <0.001), and were less likely to have undergone prior operation (3 % vs 8 %; p-value <0.001). However, disease-related quality of life impact was more severe for females than males in 5 of 6 domains examined including: pain (5 vs 3; p-value <0.001), embarrassment (4 vs 3; p-value = 0.021), ability to play sports (2 vs 1; p-value = 0.01), disruption of routine (4 vs 3; p-value = 0.024) and disturbance to school, work, or activities (3 vs 2; p-value = 0.004). More females underwent pit picking on their first clinic visit (33 % vs 27 %; p-value = 0.011) and incision and drainage (6 % vs 3 %; p-value = 0.01), with similar rates of laser follicle ablation (53 % vs 55 %; p-value = 0.45). CONCLUSION: The prevalence of pilonidal disease is much higher in females than previously reported. Pilonidal disease has different impacts on females than males including: earlier onset, higher incidence of anxiety, and greater disease-related impact on quality of life, despite lower disease severity on presentation. Tolerance of clinic treatments is comparable between genders. TYPE OF STUDY: Retrospective, cohort study. LEVEL OF EVIDENCE: III.", "provenance": [ { "field": "n", "quote": "Of 1356 patients with pilonidal disease, 562 (41 %) were female and 794 male." }, { "field": "population", "quote": "Pilonidal disease is a common, disruptive condition in adolescents." }, { "field": "intervention", "quote": "with similar rates of laser follicle ablation (53 % vs 55 %; p-value = 0.45)" }, { "field": "comparator", "quote": "More females underwent pit picking on their first clinic visit (33 % vs 27 %; p-value = 0.011) and incision and drainage (6 % vs 3 %; p-value = 0.01), with similar rates of laser follicle ablation (53 % vs 55 %; p-value = 0.45)." }, { "field": "primaryOutcome", "quote": "We studied the effects of pilonidal disease on adolescents by gender." }, { "field": "result", "quote": "with similar rates of laser follicle ablation (53 % vs 55 %; p-value = 0.45)" } ] }, { "id": "pmid:39995244", "pmid": "39995244", "doi": "10.12659/MSM.947466", "nctId": null, "pmcid": "PMC11871746", "title": "Comparative Outcomes of Surgical Techniques for Pilonidal Sinus: A Turkish Retrospective Study", "firstAuthor": "Gojayev", "multipleAuthors": true, "journal": "Med Sci Monit", "year": 2025, "design": "retrospective", "n": 422, "nField": "reported", "population": "adults with pilonidal sinus disease who had surgery", "intervention": "laser pilonidotomy", "comparator": "primary midline closure, Karydakis flap, and Limberg flap surgeries", "primaryOutcome": "complications, recurrence, recovery times, and satisfaction", "result": "laser group had shorter surgery and hospital stay, less pain, faster return to activity, and higher satisfaction", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a retrospective comparison of surgical groups, not a randomized trial, so differences between groups could be due to other factors.", "directness": "direct", "limitations": "Retrospective design; authors state studies with larger samples and longer follow-up are needed.", "followUp": "", "plainFinding": "Faster recovery, higher satisfaction with laser.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39995244/", "sourceText": "BACKGROUND Pilonidal sinus is a chronic or acute infectious disease in the intergluteal cleft. Various surgical treatments exist, but optimal management remains debated. This study compares outcomes of primary midline closure (PMC), Karydakis flap (KF), Limberg flap (LF), and laser pilonidotomy (LP) in adult patients with pilonidal sinus disease. MATERIAL AND METHODS The data of 476 patients who underwent surgery for pilonidal sinus disease in our clinic between January 2011 and September 2022 were retrospectively evaluated. After 54 patients were excluded, the remaining patients were divided into 4 groups: PMC (n=228), LF (n=82), KF (n=53), and LP (n=59). Patient characteristics, surgical findings, and quality of life outcomes were compared between the groups. RESULTS The operation time was significantly shorter in the LP group (P<0.001). Seroma (P=0.006), wound dehiscence (P<0.001), and postoperative recurrence (P=0.017) rates were significantly higher in the PMC group. Hospital stay was significantly shorter in the LP group (mean, 8 h; P<0.001). Pain-free toilet sitting time, pain-free walking time, and return to work time were statistically significantly shorter in the LP group (all P<0.001). According to the Likert scale, the satisfaction rate of the LP group was significantly higher (P<0.001). CONCLUSIONS The PMC method has a higher postoperative complication rate and a slower return to normal physical activity. The KF method appears to be more advantageous in terms of postoperative recurrence rate. Although the LP method seems to be more advantageous in terms of quality of life in selected patients, studies with larger samples and longer follow-up periods are needed.", "provenance": [ { "field": "n", "quote": "The data of 476 patients who underwent surgery for pilonidal sinus disease in our clinic between January 2011 and September 2022 were retrospectively evaluated. After 54 patients were excluded, the remaining patients were divided into 4 groups: PMC (n=228), LF (n=82), KF (n=53), and LP (n=59)." }, { "field": "population", "quote": "adult patients with pilonidal sinus disease" }, { "field": "intervention", "quote": "laser pilonidotomy (LP)" }, { "field": "comparator", "quote": "primary midline closure (PMC), Karydakis flap (KF), Limberg flap (LF)" }, { "field": "primaryOutcome", "quote": "Patient characteristics, surgical findings, and quality of life outcomes were compared between the groups." }, { "field": "result", "quote": "Hospital stay was significantly shorter in the LP group (mean, 8 h; P<0.001). Pain-free toilet sitting time, pain-free walking time, and return to work time were statistically significantly shorter in the LP group (all P<0.001). According to the Likert scale, the satisfaction rate of the LP group was significantly higher (P<0.001)." }, { "field": "limitations", "quote": "studies with larger samples and longer follow-up periods are needed" } ] }, { "id": "pmid:39969579", "pmid": "39969579", "doi": "10.1007/s00384-025-04832-x", "nctId": null, "pmcid": "PMC11839847", "title": "Efficacy and safety of laser ablation for recurrent pilonidal sinus: a systematic review and meta‑analysis", "firstAuthor": "Qin", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2025, "design": "meta-analysis", "n": 137, "nField": "reported", "population": "patients with recurrent pilonidal sinus after prior surgery", "intervention": "laser ablation of the sinus tract", "comparator": "none (single-arm pooled outcomes across studies; some had pit picking combined)", "primaryOutcome": "healing rate after treatment", "result": "about 82% of patients healed, with lower healing rates after more than 12 months follow-up", "resultDirection": "benefit", "quality": "low", "qualityWhy": "pooled from only seven small studies with high variability between them and no randomized comparison group.", "directness": "indirect", "limitations": "high heterogeneity between studies (I2=69%), declining healing rates with longer follow-up, and lack of randomized controlled trials.", "followUp": "12 months or less; some studies exceeding 12 months", "plainFinding": "Mostly healed short-term, less durable long-term.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39969579/", "sourceText": "BACKGROUND: Recurrence remains a significant challenge following the surgical treatment of sacrococcygeal pilonidal sinus. Unlike patients with primary pilonidal sinus, those with recurrent cases often present with more complex sinus tracts, and scarring from previous surgeries increases the complexity of subsequent procedures. Therefore, selecting the appropriate surgical method for patients with recurrent pilonidal sinus requires greater caution. It is essential to reassess these patients to determine whether surgical techniques suitable for primary pilonidal sinus are equally effective for recurrent cases. Laser ablation, an innovative and minimally invasive technique, has emerged as a promising option for managing pilonidal sinus. This procedure uses a circular laser at the tip of a catheter to deliver energy, effectively destroying and ablating the sinus tract while promoting its closure. Previous studies have demonstrated the safety and efficacy of laser ablation in treating primary pilonidal sinus. The objective of this systematic review and meta-analysis is to assess the efficacy and safety of laser ablation in the management of recurrent pilonidal sinus. METHODS: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was carried out using PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov. Additionally, the references of all retrieved studies were screened to identify further eligible data. The search included studies published up to June 11, 2024. The primary outcome measure was the healing rate after laser ablation, which served as the metric for evaluating the efficacy of this technique in treating recurrent pilonidal sinus. Secondary outcome measures included the incidence of severe postoperative complications, which were assessed to determine the safety profile of laser ablation. According to the Clavien-Dindo classification of postoperative complications, we define severe complications as those classified as grade IIIb or higher. RESULT: A total of seven studies were included in this meta-analysis. With the exception of one study published in 2018, the remaining six were published within the past 3 years. Two studies originated from Middle Eastern countries, while the other five were from European countries. In total, 137 patients with recurrent pilonidal sinus were included, of whom 112 achieved healing following laser ablation treatment. The pooled healing rate across these studies was 81.9% (95% CI, 65.4-94.6%; I2 = 69.12%; p < 0.01). A subgroup analysis based on follow-up duration was also performed. The pooled healing rate for studies with a follow-up period of 12 months or less was 87.2% (95% CI, 63.2-100%; I2 = 78.57%; p < 0.01), while for studies with a follow-up duration exceeding 12 months, the pooled healing rate was 74.5% (95% CI, 51.5-92.7%; I2 = 47.48%; p = 0.15). In addition, five studies performed pit picking before laser ablation, while two studies did not. We conducted a subgroup analysis based on whether pit picking was performed before laser ablation. The results of the subgroup analysis indicated that the difference in efficacy between combined pit picking and laser ablation alone was not statistically significant (random effects model, p = 0.75). This suggests that both treatment methods may have similar effectiveness in the management of recurrent pilonidal sinus disease. CONCLUSIONS: This meta-analysis demonstrates that laser ablation is an effective and safe method for the treatment of recurrent sacrococcygeal pilonidal sinus in the short term. However, the findings indicate a trend toward a lower healing rate with extended follow-up periods. To better assess the long-term efficacy of laser ablation in managing recurrent pilonidal sinus, high-quality randomized controlled trials with extended follow-up durations are necessary.", "provenance": [ { "field": "population", "quote": "137 patients with recurrent pilonidal sinus were included" }, { "field": "intervention", "quote": "laser ablation treatment" }, { "field": "comparator", "quote": "the difference in efficacy between combined pit picking and laser ablation alone was not statistically significant" }, { "field": "primaryOutcome", "quote": "The primary outcome measure was the healing rate after laser ablation" }, { "field": "result", "quote": "The pooled healing rate across these studies was 81.9% (95% CI, 65.4-94.6%; I2 = 69.12%; p < 0.01)" }, { "field": "result", "quote": "for studies with a follow-up duration exceeding 12 months, the pooled healing rate was 74.5%" }, { "field": "n", "quote": "In total, 137 patients with recurrent pilonidal sinus were included, of whom 112 achieved healing" } ] }, { "id": "pmid:39953215", "pmid": "39953215", "doi": "10.1007/s10103-025-04341-x", "nctId": null, "pmcid": null, "title": "Laser versus rhomboid flap for sacrococcygeal pilonidal sinus: multi-centre comparative study", "firstAuthor": "Alwadees", "multipleAuthors": true, "journal": "Lasers Med Sci", "year": 2025, "design": "retrospective", "n": 374, "nField": "reported", "population": "people aged 16-70 with pilonidal sinus who had never had surgery before", "intervention": "laser ablation", "comparator": "open rhomboid flap surgery", "primaryOutcome": "recurrence rate after treatment", "result": "laser treatment had a significantly higher recurrence rate than the open rhomboid flap surgery", "resultDirection": "harm", "quality": "low", "qualityWhy": "This was a non-randomised comparison between hospitals, so differences between patient groups could explain the results rather than the treatment itself.", "directness": "direct", "limitations": "Not described as randomized; abstract does not report how patients were assigned to groups or control for confounding.", "followUp": "3 months", "plainFinding": "More recurrence than open surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": true, "url": "https://pubmed.ncbi.nlm.nih.gov/39953215/", "sourceText": "Pilonidal sinus is a condition affecting young people. Several management methods are available. The two popular approaches are laser ablation and open techniques. This study aims to assess the recurrence rate after both techniques. This is a government and private hospital setting. Patients are included if they are diagnosed with pilonidal sinus, between the ages of 16 and 70, and have never had surgery before. Diabetic patients and patients with immune deficiency status who are younger than 16 or older than 70 are excluded. The operations are done by senior consultant surgeons. Patients are seen for 4 weeks or 3 months and discharged if there are no complications. 190 and 184 patients were selected for the laser and open groups, respectively. There are 142 men and 42 women in the open group compared to 140 men and 50 women in the laser group, with p-value: of 0.472. There was no significant difference in age, body mass index, or obesity between the two groups. There is a significantly higher recurrence rate in the laser group value: <0.00001. No significant difference in the recurrence rate for one or more than one opening disease within the open group. The laser technique is associated with a higher recurrence rate compared to the open rhomboid flap technique. One opening pilonidal sinus is significantly showing better results within the laser group but no significant difference in the open group.", "provenance": [ { "field": "n", "quote": "190 and 184 patients were selected for the laser and open groups, respectively." }, { "field": "population", "quote": "Patients are included if they are diagnosed with pilonidal sinus, between the ages of 16 and 70, and have never had surgery before." }, { "field": "intervention", "quote": "laser ablation and open techniques" }, { "field": "comparator", "quote": "open rhomboid flap technique" }, { "field": "primaryOutcome", "quote": "This study aims to assess the recurrence rate after both techniques." }, { "field": "result", "quote": "There is a significantly higher recurrence rate in the laser group value: <0.00001." }, { "field": "followUp", "quote": "Patients are seen for 4 weeks or 3 months and discharged if there are no complications." } ] }, { "id": "pmid:39920899", "pmid": "39920899", "doi": "10.1111/codi.70020", "nctId": null, "pmcid": null, "title": "Current surgical practices and attitudes toward pilonidal sinus disease among Russian surgeons: A national survey", "firstAuthor": "Shlyk", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2025, "design": "registry", "n": 158, "nField": "reported", "population": "Russian surgeons who treat pilonidal sinus disease", "intervention": "use of laser therapy for pilonidal sinus disease", "comparator": "other surgical techniques such as excision with midline closure, open healing, marsupialization", "primaryOutcome": "survey responses describing current surgical practices and attitudes toward pilonidal sinus disease", "result": "About half of surgeons had access to laser therapy, but only 16% actually used laser-assisted closure; the study reports practice patterns, not treatment outcomes", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a survey of surgeons' practice habits, not a study comparing patient outcomes, so it cannot show whether laser treatment actually works.", "directness": "indirect", "limitations": "Self-reported survey data on practice patterns, not a comparative outcome study of laser versus other treatments", "followUp": "", "plainFinding": "No efficacy data reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39920899/", "sourceText": "AIM: Pilonidal sinus disease (PSD), also known as pilonidal disease, is a common chronic disorder in coloproctology and general surgery. It predominantly affects young male patients and is typically located in the sacrococcygeal region. Nowadays, various approaches are used to address this condition, but no consensus on a gold standard has been established. The aim of this study was to analyse and assess current PSD practice, diagnostic and surgical approaches, training and attitudes among Russian surgeons. METHOD: A comprehensive online survey comprising 35 structured questions was developed by the Russian Society of Colorectal Surgeons and distributed to its members. The survey targeted colorectal and general surgeons and collected data on demographics, professional experience, surgical training, PSD management practices and both elective and abscess surgery techniques. Categorical data are reported as frequencies and percentages. RESULTS: Of the 158 respondents, the vast majority were coloproctologists and general surgeons (n = 152, 96%) with over 10 years of experience (n = 110, 69.6%) and performing 10-50 operations per year. The most popular surgical procedures were excision with midline closure (68%), open healing (62%) and marsupialization (59%). PSD-associated abscesses were managed through incision and drainage by 81 surgeons (51%). About half of surgeons had access to laser therapy for treating PSD, but sinus laser-assisted closure was used by only 16%. Most surgeons had received training in PSD surgery under specialist supervision and felt sufficiently trained. CONCLUSION: Our findings suggest that PSD surgery in Russia has not yet shifted from midline excisions to off-midline flap procedures and minimally invasive surgery. This study calls for attention to this underprioritized group of patients and underscores the importance of developing national guidelines in Russia.", "provenance": [ { "field": "n", "quote": "Of the 158 respondents" }, { "field": "population", "quote": "The survey targeted colorectal and general surgeons" }, { "field": "intervention", "quote": "About half of surgeons had access to laser therapy for treating PSD, but sinus laser-assisted closure was used by only 16%" }, { "field": "comparator", "quote": "The most popular surgical procedures were excision with midline closure (68%), open healing (62%) and marsupialization (59%)" }, { "field": "primaryOutcome", "quote": "The aim of this study was to analyse and assess current PSD practice, diagnostic and surgical approaches, training and attitudes among Russian surgeons" }, { "field": "result", "quote": "About half of surgeons had access to laser therapy for treating PSD, but sinus laser-assisted closure was used by only 16%" } ] }, { "id": "pmid:39893840", "pmid": "39893840", "doi": "10.1016/j.jpedsurg.2025.162182", "nctId": null, "pmcid": "PMC11993338", "title": "Laser Hair Removal May Be a Primary Treatment of Pilonidal Disease: A Pilot Study", "firstAuthor": "Janek", "multipleAuthors": true, "journal": "J Pediatr Surg", "year": 2025, "design": "prospective-cohort", "n": 22, "nField": "reported", "population": "adolescents and young adults ages 13-35 with moderate to severe pilonidal disease referred for surgery", "intervention": "laser hair removal with long-pulsed Alexandrite laser as primary treatment", "comparator": "no comparator group; outcomes tracked before/after laser treatment and with subsequent surgery if needed", "primaryOutcome": "resolution without surgery, and recurrence rates after surgery in those who still needed it", "result": "40% of patients who completed laser sessions resolved without surgery; among those who still needed surgery, 67% resolved after one operation; quality of life scores improved", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small, single-center pilot study with no comparison group, so it can't prove the laser itself caused the improvement.", "directness": "direct", "limitations": "Small sample size, no control group, some patients withdrew before completing treatment, single center and single dermatologist performing laser treatment.", "followUp": "18 months", "plainFinding": "Fewer needed surgery, better quality of life.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39893840/", "sourceText": "INTRODUCTION: Pilonidal disease is a chronic skin disorder of the gluteal cleft in adolescents and young adults. No treatment is universally effective, and the heterogeneity of the disease and variability in treatment response frustrates patients and clinicians alike. Surgical treatment strategies focus on the removal of the sinus tracts. Post-operative laser hair removal (LHR) has demonstrated promise to reduce disease recurrence following surgery. LHR has yet to be investigated as a primary treatment strategy and may offer additional benefits. METHODS: A single-center prospective pilot study investigated laser hair removal as the primary treatment for moderate to severe pilonidal disease. Patients ages 13-35 with moderate to severe disease who were referred for surgical excision were recruited. Participants underwent 3-8 treatment sessions with the long-pulsed--Alexandrite (755 nm) laser by a dermatologist until hair removal endpoints were met. Patients with persistent symptoms after LHR underwent subsequent excision. Patients were subsequently followed in the pediatric surgery clinic at 6, 9, 12 and 18 months following LHR to evaluate for disease recurrence. Primary outcomes included resolution rates without surgical intervention and recurrence rates following surgical resection. Secondary outcomes included the number of episodes of infection and impact on quality of life, as assessed by the Dermatology Life Quality Index (DLQI) in patients ≥16 years of age, and the Children's Dermatology Life Quality Index (CDLQI) in patients <16 years of age. RESULTS: Twenty-two patients were enrolled, of which 18 were initiated and 15 completed the LHR sessions in the study, designed to the endpoint of the absence of terminal hair in the gluteal cleft. One patient withdrew prior to completion of the LHR sessions, and two withdrew from the study due to the COVID-19 pandemic. Of the 15 patients who completed the LHR sessions, all demonstrated significant improvement in hair follicle density in the treatment area, with no adverse events. Median number of laser treatments was 6. Six of 15 (40 %) who completed laser treatments had resolution without surgical intervention. Nine patients underwent surgery, of which 6 (67 %) resolved after one surgery, with 18 months of follow up to evaluate for recurrence. Quality of life scores improved after laser treatments (DLQI mean change -4.6, and Children's DLQI mean change -6.0) CONCLUSION: Laser hair removal was well tolerated, without adverse events and with improved quality of life, in a patient population with moderate to severe pilonidal disease. Nearly half of patients had disease resolution without the need for surgical intervention. These findings underscore the potential for laser hair removal to improve disease outcomes in pilonidal disease, reducing the need for surgical intervention. Based on these results, laser hair removal might provide an effective primary treatment strategy for some patients, and could improve outcomes for those who require surgical intervention. Further research is needed to determine which patients would most likely benefit from this treatment strategy. LEVEL OF EVIDENCE: Level III.", "provenance": [ { "field": "n", "quote": "Twenty-two patients were enrolled" }, { "field": "population", "quote": "Patients ages 13-35 with moderate to severe disease who were referred for surgical excision were recruited." }, { "field": "intervention", "quote": "Participants underwent 3-8 treatment sessions with the long-pulsed--Alexandrite (755 nm) laser by a dermatologist until hair removal endpoints were met." }, { "field": "comparator", "quote": "Patients with persistent symptoms after LHR underwent subsequent excision." }, { "field": "primaryOutcome", "quote": "Primary outcomes included resolution rates without surgical intervention and recurrence rates following surgical resection." }, { "field": "result", "quote": "Six of 15 (40 %) who completed laser treatments had resolution without surgical intervention. Nine patients underwent surgery, of which 6 (67 %) resolved after one surgery" }, { "field": "result", "quote": "Quality of life scores improved after laser treatments (DLQI mean change -4.6, and Children's DLQI mean change -6.0)" } ] }, { "id": "pmid:39875233", "pmid": "39875233", "doi": "10.1016/j.jviscsurg.2024.12.005", "nctId": null, "pmcid": null, "title": "Management of pilonidal sinus and recurrences in 2025", "firstAuthor": "Darnis", "multipleAuthors": true, "journal": "J Visc Surg", "year": 2025, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus, including those with treatment failures or recurrences", "intervention": "minimally invasive techniques including laser treatment", "comparator": "radical excision followed by secondary healing", "primaryOutcome": "recurrence rate", "result": "equivalent recurrence rate to excision, but easier recovery and avoids difficult wound care", "resultDirection": "mixed", "quality": "very-low", "qualityWhy": "This is a narrative review describing general treatment strategies without presenting original study data or numbers for laser treatment.", "directness": "indirect", "limitations": "No patient numbers, no study design details, no statistics are given for laser treatment specifically; it is a general narrative review of pilonidal sinus management.", "followUp": "", "plainFinding": "Similar recurrence, easier recovery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39875233/", "sourceText": "Pilonidal sinus is a common pathology of the intergluteal cleft that can develop into abscess or suppuration. This lesion corresponds histologically to a granuloma that organizes around foreign bodies, most often hairs, and fistulizes to the skin through partially epithelialized orifices. If suppuration and abscess develop, treatment is based either on medical treatment combining analgesics, local antiseptics and sometimes antibiotics, or on emergency incision and drainage in the operating room. This is performed in more than 10,000 patients per year in France. Outside of emergencies, elective surgery for pilonidal sinus is indicated to treat bothersome symptoms or to avoid the risk of recurrent abscess. The surgical indication must take into account the patient's risk factors, particularly active smoking, that increase the risk of postoperative complications and recurrence. Elective intervention is performed on more than 30,000 patients per year in France. Radical excision followed by secondary healing is the most commonly performed option. This strategy carries a risk of failure or recurrence for at least 10% of patients. Primary closure after excision can reduce the time for healing and convalescence, but at the cost of more frequent infectious complications. Midline closure should be avoided, in favor of paramedian or flap closure. Minimally invasive techniques are being developed that combine the extraction of foreign bodies and mechanical debridement or thermal or chemical cautery of the granulomatous walls. They avoid complex and unpleasant nursing care of secondarily healing wounds, at the cost of a recurrence rate equivalent to that from excision techniques. They have the merit of avoiding difficult situations of failure to heal or recurrence after radical excision that are associated with a clear deterioration in the quality of life. The treatment of surgical failures is complex, and combines comprehensive patient care (smoking cessation, anti-infectious treatments, treatment of excess weight, avoidance of a sedentary lifestyle) and often a repeat operation. Minimally invasive treatments, particularly laser treatments, have their place in these difficult situations.", "provenance": [ { "field": "intervention", "quote": "Minimally invasive techniques are being developed that combine the extraction of foreign bodies and mechanical debridement or thermal or chemical cautery of the granulomatous walls." }, { "field": "comparator", "quote": "Radical excision followed by secondary healing is the most commonly performed option." }, { "field": "primaryOutcome", "quote": "at the cost of a recurrence rate equivalent to that from excision techniques" }, { "field": "result", "quote": "They avoid complex and unpleasant nursing care of secondarily healing wounds, at the cost of a recurrence rate equivalent to that from excision techniques." }, { "field": "population", "quote": "The treatment of surgical failures is complex, and combines comprehensive patient care" }, { "field": "intervention", "quote": "Minimally invasive treatments, particularly laser treatments, have their place in these difficult situations." } ] }, { "id": "pmid:39834506", "pmid": "39834506", "doi": "10.3389/fsurg.2024.1494382", "nctId": null, "pmcid": "PMC11743505", "title": "Evaluating efficacy and outcomes: comparison of laser treatment and crystallized phenol in pilonidal sinus disease", "firstAuthor": "Emral", "multipleAuthors": true, "journal": "Front Surg", "year": 2024, "design": "retrospective", "n": 121, "nField": "reported", "population": "patients with pilonidal sinus disease", "intervention": "laser ablation", "comparator": "crystallized phenol application", "primaryOutcome": "wound healing time and post-surgery pain scores", "result": "laser treatment had faster healing and less pain than phenol", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective review comparing two treatments without randomization, so differences between patient groups could affect results.", "directness": "direct", "limitations": "Retrospective design; not randomized; data reviewed after the fact rather than controlled prospectively.", "followUp": "", "plainFinding": "Faster healing, less pain than phenol.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39834506/", "sourceText": "OBJECTIVE: The aim of this study is to comprehensively evaluate the efficacy of laser ablation and crystallized phenol application in the treatment of pilonidal sinus disease, focusing on treatment success, recurrence rates, complications, and the patients' return to normal life. MATERIAL AND METHOD: Data from patients treated for pilonidal sinus disease with laser ablation and crystallized phenol application at our clinic between January 2020 and September 2023 were retrospectively reviewed. Preoperative data including pit counts, disease stage, preoperative pilonidal abscess history, disease duration (week), treatment success, recurrence/persistent disease, postoperative complications, healing time (days), and visual analogue scale (VAS) scores on postoperative days 1 and 7, as well as return to normal life (days), were analyzed. RESULTS: A total of 121 patients were included in the study, with 51 receiving laser ablation and 70 receiving crystallized phenol application. The postoperative outcomes revealed that the wound healing period and postoperative VAS values were statistically significantly better in the laser ablation group. CONCLUSION: Wound healing was faster and postoperative pain was less in the laser group compared to the phenol group. According to this study, both methods can successfully treat the disease in selected cases.", "provenance": [ { "field": "population", "quote": "patients treated for pilonidal sinus disease" }, { "field": "intervention", "quote": "laser ablation" }, { "field": "comparator", "quote": "crystallized phenol application" }, { "field": "primaryOutcome", "quote": "wound healing period and postoperative VAS values" }, { "field": "result", "quote": "Wound healing was faster and postoperative pain was less in the laser group compared to the phenol group." }, { "field": "n", "quote": "A total of 121 patients were included in the study, with 51 receiving laser ablation and 70 receiving crystallized phenol application." } ] }, { "id": "pmid:39815683", "pmid": "39815683", "doi": "10.1093/ced/llaf035", "nctId": null, "pmcid": null, "title": "Laser hair depilation therapy for pilonidal sinus disease: a 5-year, retrospective experience in a university teaching hospital in the UK, 2017-2023", "firstAuthor": "Andrew", "multipleAuthors": true, "journal": "Clin Exp Dermatol", "year": 2025, "design": "retrospective", "n": 97, "nField": "reported", "population": "patients with pilonidal sinus disease referred for laser hair removal, mostly young men", "intervention": "laser hair depilation therapy", "comparator": "no formal comparator; outcomes compared by number of laser sessions and whether surgery was also done", "primaryOutcome": "improvement or healing of pilonidal sinus disease", "result": "more laser sessions predicted symptom resolution; in patients treated with laser alone (no surgery), 78% improved or healed; surgery type was not linked to improvement; one recurrence and no complications", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a retrospective review of medical records without a control group, so it cannot prove the laser itself caused the improvement.", "directness": "direct", "limitations": "Retrospective design, no control group, single center, outcome categorization may be subjective.", "followUp": "", "plainFinding": "Mostly improved or healed with laser.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39815683/", "sourceText": "BACKGROUND: Pilonidal sinus disease (PSD) is a chronic, debilitating condition predominantly affecting young men. Laser hair depilation is an established adjunct to surgical treatment for PSD. It can lead to reduced rates of recurrence and postsurgical interventions. OBJECTIVES: To assess the outcome of laser hair depilation therapy on disease progression in patients with PSD at the Birmingham Skin Regional Laser Centre. METHODS: Patient demographics, PSD clinical stage, laser type, number of laser sessions, surgical intervention and treatment outcomes were extracted from electronic medical records of patients (n = 97) referred for laser hair depilation between 2017 and 2023. Statistical analysis was performed using Microsoft Excel and R. Treatment outcomes were categorized as improvement (healed, improved) or no improvement of underlying PSD. Disease severity was classified using the method of Guner et al. (BMC Surg 2016; 16:18). RESULTS: Most patients affected were male (77%). The median age was 22 years (interquartile range 20-28). The median number of laser hair removal sessions was 8 (interquartile range 5.5-10). The number of laser hair removal sessions was the only predictive factor for symptom resolution (P < 0.001). Neither surgical intervention nor the type of surgery (incision, excision, modified flap, or endoscopic surgical intervention) showed a significant association with improvement in PSD (P = 0.47 and P = 0.65, respectively). In the subgroup of patients who did not undergo surgery (n = 32, 33%), 25 patients (78%) had improvement or healing in their PSD. There were no statistically significant associations between age, type of laser, disease severity and benefit from laser hair removal. No complications were reported and there was only one case of recurrence. CONCLUSIONS: Laser hair depilation is a safe and effective postoperative adjunct treatment for treating sacrococcygeal PSD. For early-stage disease it may offer curative treatment.", "provenance": [ { "field": "n", "quote": "Patient demographics, PSD clinical stage, laser type, number of laser sessions, surgical intervention and treatment outcomes were extracted from electronic medical records of patients (n = 97) referred for laser hair depilation between 2017 and 2023." }, { "field": "population", "quote": "Most patients affected were male (77%). The median age was 22 years (interquartile range 20-28)." }, { "field": "intervention", "quote": "Laser hair depilation is an established adjunct to surgical treatment for PSD." }, { "field": "comparator", "quote": "Neither surgical intervention nor the type of surgery (incision, excision, modified flap, or endoscopic surgical intervention) showed a significant association with improvement in PSD (P = 0.47 and P = 0.65, respectively)." }, { "field": "primaryOutcome", "quote": "Treatment outcomes were categorized as improvement (healed, improved) or no improvement of underlying PSD." }, { "field": "result", "quote": "In the subgroup of patients who did not undergo surgery (n = 32, 33%), 25 patients (78%) had improvement or healing in their PSD." }, { "field": "result", "quote": "The number of laser hair removal sessions was the only predictive factor for symptom resolution (P < 0.001)." }, { "field": "result", "quote": "No complications were reported and there was only one case of recurrence." } ] }, { "id": "pmid:39699772", "pmid": "39699772", "doi": "10.1007/s10151-024-03058-3", "nctId": null, "pmcid": null, "title": "Sinus laser therapy versus Karydakis flap procedure in the management of pilonidal sinus disease: a comparative analysis of intraoperative parameters and postoperative outcome", "firstAuthor": "Akyol", "multipleAuthors": false, "journal": "Tech Coloproctol", "year": 2024, "design": "retrospective", "n": 106, "nField": "reported", "population": "patients with pilonidal sinus disease", "intervention": "sinus laser therapy (SiLaT)", "comparator": "Karydakis flap surgery", "primaryOutcome": "operative time, pain, return to work, complications, and recurrence", "result": "laser therapy had shorter operative time, less pain, and faster return to work, with similar complication and recurrence rates", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this was a retrospective comparison without randomization, so differences between groups could be due to other factors, not just the treatment.", "directness": "direct", "limitations": "retrospective design, not randomized", "followUp": "", "plainFinding": "Less pain, faster recovery, similar cure", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39699772/", "sourceText": "BACKGROUND: This study aimed to investigate the utility of minimally invasive sinus laser therapy (SiLaT) versus flap surgery (Karydakis flap procedure) in terms of intraoperative parameters and postoperative outcome in patients with pilonidal sinus disease (PSD). METHODS: A total of 106 patients with PSD (mean ± SD age: 26.4 ± 7.0 years, 86.8% male) treated with Karydakis flap procedure (KF group; n = 63) or sinus laser therapy (SiLaT group; n = 43) were included in this retrospective study. Data on patient demographics, operative characteristics (number of openings, length of sinus tract, and operative time), and postoperative outcome including postoperative (day 1) pain intensity-visual analog scale (VAS) scores, time to return to work after surgery (days), complication rate, and recurrence rate were recorded in each patient and compared between KF and SiLaT groups. RESULTS: The SiLaT versus KF procedure was associated with significantly shorter operative time [median (min-max) 17 (12-28) versus 27 (20-44) min, p = 0.001], lower pain scores [3 (1-4) versus 5 (3-7), p = 0.001], and earlier return to work [1 (1-3) versus 10 (5-20) days, p = 0.001]. Although no significant difference was noted in complication and recurrence rates between the KF and SiLaT groups, 6.3% (wound infection only) and 3.2% of patients in the KF group but none of the patients in the SiLaT group developed complication and recurrence, respectively. CONCLUSIONS: SiLaT seems to be a promising minimally invasive technique for the management of PSD, being comparable to the KF procedure in terms of complications and recurrence, along with added advantages of shorter operative time, reduced postoperative pain, and earlier return to work.", "provenance": [ { "field": "population", "quote": "patients with pilonidal sinus disease (PSD)" }, { "field": "n", "quote": "A total of 106 patients with PSD" }, { "field": "intervention", "quote": "sinus laser therapy (SiLaT)" }, { "field": "comparator", "quote": "Karydakis flap procedure" }, { "field": "primaryOutcome", "quote": "postoperative (day 1) pain intensity-visual analog scale (VAS) scores, time to return to work after surgery (days), complication rate, and recurrence rate" }, { "field": "result", "quote": "significantly shorter operative time [median (min-max) 17 (12-28) versus 27 (20-44) min, p = 0.001], lower pain scores [3 (1-4) versus 5 (3-7), p = 0.001], and earlier return to work [1 (1-3) versus 10 (5-20) days, p = 0.001]" }, { "field": "result", "quote": "no significant difference was noted in complication and recurrence rates between the KF and SiLaT groups" }, { "field": "limitations", "quote": "retrospective study" } ] }, { "id": "pmid:39578271", "pmid": "39578271", "doi": "10.1007/s10103-024-04239-0", "nctId": null, "pmcid": null, "title": "Does the holmium laser have a place in the treatment of pilonidal cysts? (Pilolas study)", "firstAuthor": "Darnis", "multipleAuthors": true, "journal": "Lasers Med Sci", "year": 2024, "design": "retrospective", "n": null, "nField": "not-reported", "population": "people treated for pilonidal cysts", "intervention": "holmium laser treatment", "comparator": "SiLaT laser treatment", "primaryOutcome": "cure (healing) rate one month after treatment", "result": "healing rate was 90.7% at one month, similar to SiLaT laser, but with more pain, infection, and recurrence", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "This was a retrospective study without a direct control group, comparing results to another laser method from prior data, which makes the comparison less reliable.", "directness": "direct", "limitations": "Retrospective design; comparison to SiLaT laser was indirect, not a randomized head-to-head trial; follow-up for complications extended up to a year but methods for tracking this were not detailed.", "followUp": "up to a year after the procedure", "plainFinding": "Similar healing, more pain and complications.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39578271/", "sourceText": "Recently, a minimally invasive procedure based on a laser technique (SiLaT) has been developed for the treatment of pilonidal cysts. Although less invasive and less painful than surgery, this solution is nevertheless limited by its high cost. Other more affordable laser devices, such as the holmium laser, are also used in minimally invasive surgery. The objective of this study was to evaluate the possibility of using the holmium laser instead of the SiLaT laser in the treatment of pilonidal cysts. Retrospective cohort study with the primary endpoint being the cure rate one month after treatment. Median duration of local care was 21 days (mean = 22 ± 7.5) and healing rate at 1 month was 90.7%. During follow-up, 102 patients (44.9%) experienced pain in the coccygeal region often exacerbated by sitting and significantly more common in people with a small frame, overwhelmingly female. A surgical site infection was reported in 36 patients (15.9%). Recurrence, occurred in 39 patients (17.2%), was related to cyst type (type 1 do not recur, type 3 recur twice three time than type 2). Holmium laser does not differ from SiLaT laser in the healing rate of pilonidal cysts after treatment. However, it is characterised by a moderately higher incidence of complications, foremost of which is the occurrence of pain that can persist for up to a year after the procedure and which could be related to an increase in heat inherent to the use of holmium. As a result, this procedure does not seem to represent an alternative to SiLaT.", "provenance": [ { "field": "primaryOutcome", "quote": "Retrospective cohort study with the primary endpoint being the cure rate one month after treatment." }, { "field": "result", "quote": "healing rate at 1 month was 90.7%" }, { "field": "result", "quote": "Holmium laser does not differ from SiLaT laser in the healing rate of pilonidal cysts after treatment. However, it is characterised by a moderately higher incidence of complications" }, { "field": "intervention", "quote": "the holmium laser instead of the SiLaT laser in the treatment of pilonidal cysts" }, { "field": "comparator", "quote": "the holmium laser instead of the SiLaT laser in the treatment of pilonidal cysts" }, { "field": "population", "quote": "treatment of pilonidal cysts" }, { "field": "followUp", "quote": "pain that can persist for up to a year after the procedure" } ] }, { "id": "pmid:39364530", "pmid": "39364530", "doi": "10.7759/cureus.68502", "nctId": null, "pmcid": "PMC11449080", "title": "Advancements in Surgical Approaches for Sacrococcygeal Pilonidal Sinus: A Comprehensive Review", "firstAuthor": "Shinde", "multipleAuthors": true, "journal": "Cureus", "year": 2024, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus (a cavity/sinus near the tailbone)", "intervention": "newer surgical techniques including endoscopic and laser-assisted procedures", "comparator": "traditional surgery such as excision with primary closure", "primaryOutcome": "clinical outcomes, recurrence rates, complications, and patient satisfaction", "result": "The abstract summarizes that the review compares techniques but does not give specific results or data for laser treatment", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a narrative review with no reported study data, numbers, or statistical results, so it cannot show whether laser treatment works.", "directness": "indirect", "limitations": "No specific outcome data, numbers, or statistics are given for laser-assisted treatment; it is a general overview rather than a study with results.", "followUp": "", "plainFinding": "No specific results reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39364530/", "sourceText": "Sacrococcygeal pilonidal sinus (SPS) is a condition involving the formation of a cavity in the lower back region. It is more common among young adults and is influenced by factors such as sitting for long periods, body hair, and certain lifestyle habits. Surgical treatment is often necessary for recurring or severe cases, and various surgical techniques available, ranging from traditional surgical methods to newer, less invasive approaches. This comprehensive review examines the progress in surgical techniques for managing SPS, emphasizing the effectiveness, safety, and patient outcomes associated with different methods. It provides an overview of traditional procedures, such as excision with primary closure, and contrasts these with recent innovations like endoscopic and laser-assisted techniques. The review also considers advanced technologies, including the potential of robotic surgery and the use of specialized materials. By assessing clinical outcomes, recurrence rates, complications, and patient satisfaction, this review seeks to identify the most effective surgical strategies for SPS. Additionally, it discusses recent technological advancements and highlights areas needing further research to improve the management and treatment of this condition.", "provenance": [ { "field": "population", "quote": "Sacrococcygeal pilonidal sinus (SPS) is a condition involving the formation of a cavity in the lower back region." }, { "field": "intervention", "quote": "recent innovations like endoscopic and laser-assisted techniques" }, { "field": "comparator", "quote": "traditional procedures, such as excision with primary closure" }, { "field": "primaryOutcome", "quote": "assessing clinical outcomes, recurrence rates, complications, and patient satisfaction" }, { "field": "result", "quote": "this review seeks to identify the most effective surgical strategies for SPS" } ] }, { "id": "pmid:39357489", "pmid": "39357489", "doi": "10.1016/j.ijscr.2024.110384", "nctId": null, "pmcid": "PMC11471657", "title": "Peri anal region is an overlooked location for pilonidal recurrence after surgical excision and closure - A case series", "firstAuthor": "Jo", "multipleAuthors": true, "journal": "Int J Surg Case Rep", "year": 2024, "design": "case-series", "n": 5, "nField": "reported", "population": "patients with recurrent pilonidal disease and perianal wounds after previous surgical excision and flap closure", "intervention": "regular manual and laser epilation (hair removal), with one patient also undergoing a Gips procedure", "comparator": "none (no comparison group)", "primaryOutcome": "wound healing of perianal pilonidal wounds", "result": "all five patients' wounds healed", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a tiny case series of only 5 patients with no comparison group, so it cannot reliably show whether laser treatment itself works.", "directness": "indirect", "limitations": "Very small sample size, no control group, combined with manual epilation and sometimes surgery, so the effect of laser alone cannot be separated.", "followUp": "", "plainFinding": "Wounds healed with laser hair removal.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39357489/", "sourceText": "INTRODUCTION AND IMPORTANCE: Patients with pilonidal disease (PD) often undergo wide excision of pilonidal sinuses and flap-based closures. Patients who failed these procedures can have recurrent perianal wounds obscured by hair and unrecognized even by the treating physicians. In this report, we describe a series of pilonidal patients with recurrent disease and perianal wounds. CASE PRESENTATION: Five pilonidal patients with recurrent disease after surgical excision and flap closure were referred to our Pilonidal Care Clinic. All five were found to have perianal wounds. Each patient was treated with regular manual and laser epilation and only one patient required a Gips procedure. All wounds were successfully healed. CLINICAL DISCUSSION: After removal of hair at the perianal region, patients with recurrent pilonidal disease can expose a pilonidal sinus that was previously unrecognized. Peri-anal wounds can have poor wound healing due to the close proximity of the wound to the anal verge, risk of contamination, difficulty of consistent observation of the wound, and moist environment of the anus that retains bacteria. Careful consideration of proper wound care post-excision of perianal pilonidal sinuses should be prioritized. CONCLUSIONS: Pilonidal perianal wounds after previous surgical excision and flap closure can be obscured by hair, resulting in recurrent pain and drainage. The perianal wounds can be successfully healed with regular manual and laser epilation and selectively excised using Gips procedure.", "provenance": [ { "field": "population", "quote": "Five pilonidal patients with recurrent disease after surgical excision and flap closure were referred to our Pilonidal Care Clinic. All five were found to have perianal wounds." }, { "field": "intervention", "quote": "Each patient was treated with regular manual and laser epilation and only one patient required a Gips procedure." }, { "field": "comparator", "quote": "Each patient was treated with regular manual and laser epilation and only one patient required a Gips procedure." }, { "field": "primaryOutcome", "quote": "All wounds were successfully healed." }, { "field": "result", "quote": "All wounds were successfully healed." }, { "field": "n", "quote": "Five pilonidal patients with recurrent disease after surgical excision and flap closure were referred to our Pilonidal Care Clinic." } ] }, { "id": "pmid:39174833", "pmid": "39174833", "doi": "10.1007/s00423-024-03455-0", "nctId": null, "pmcid": "PMC11341738", "title": "Long-term follow-up of pilonidal sinus disease treated by radial laser surgery", "firstAuthor": "Karita", "multipleAuthors": true, "journal": "Langenbecks Arch Surg", "year": 2024, "design": "retrospective", "n": 83, "nField": "reported", "population": "patients with pilonidal sinus disease", "intervention": "radial laser surgery", "comparator": "none (single-arm, before/after outcomes only)", "primaryOutcome": "long-term recurrence of pilonidal sinus disease", "result": "14.5% recurrence rate and 27.7% needed a second operation over a median 5.2 years follow-up", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a retrospective single-group study with no comparison group, so it cannot show whether laser works better than other treatments.", "directness": "direct", "limitations": "Retrospective design, no control group for comparison", "followUp": "median 5.2 years, range 1.5 to 7.4 years", "plainFinding": "About 1 in 7 recurred", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39174833/", "sourceText": "PURPOSE: Laser ablation is one of the newest and most advanced minimally invasive techniques in treating pilonidal sinus disease (PSD). Most studies on the subject have small sample sizes and relatively short follow-up times, making evaluation of long-term healing rates and recurrences difficult. Furthermore, long-term results for laser surgery of PSD are still lacking. The aim of this study was to retrospectively report long-term follow-up results for PSD treatment by radial laser surgery. METHODS: We retrospectively studied the medical records of 83 patients who underwent the radial laser procedure for PSD between January 2017 and September 2019. Our follow-up time was a median of 5.2 years, range 1.5 to 7.4 years. RESULTS: Twelve patients had a PSD recurrence after their laser procedure, which gives a recurrence rate of 14.5% (95% CI 8.2%-23.2%). These recurrences appeared at a median 12.2 months after the laser procedure, range 4.2 to 51 months. A total of 23 patients (27.7%; 95% CI 19.0-38.0) underwent a reoperation, 11 patients due to postoperative infection or prolonged recovery and 12 patients due to PSD recurrence. Recurrent PSD and spillage of pus during operation were statistically significantly associated with the need for a second operation. CONCLUSION: Radial laser surgery provides a minimally invasive treatment option with an acceptable recurrence rate in long-term follow-up.", "provenance": [ { "field": "n", "quote": "We retrospectively studied the medical records of 83 patients who underwent the radial laser procedure for PSD between January 2017 and September 2019." }, { "field": "population", "quote": "patients who underwent the radial laser procedure for PSD" }, { "field": "intervention", "quote": "radial laser procedure for PSD" }, { "field": "comparator", "quote": "Our follow-up time was a median of 5.2 years, range 1.5 to 7.4 years." }, { "field": "primaryOutcome", "quote": "Twelve patients had a PSD recurrence after their laser procedure, which gives a recurrence rate of 14.5%" }, { "field": "result", "quote": "Twelve patients had a PSD recurrence after their laser procedure, which gives a recurrence rate of 14.5% (95% CI 8.2%-23.2%)." }, { "field": "result", "quote": "A total of 23 patients (27.7%; 95% CI 19.0-38.0) underwent a reoperation, 11 patients due to postoperative infection or prolonged recovery and 12 patients due to PSD recurrence." }, { "field": "followUp", "quote": "Our follow-up time was a median of 5.2 years, range 1.5 to 7.4 years." } ] }, { "id": "pmid:39141158", "pmid": "39141158", "doi": "10.1007/s10151-024-02972-w", "nctId": null, "pmcid": "PMC11324676", "title": "Adolescent pilonidal disease laser treatment (a-PiLaT): a pilot study", "firstAuthor": "Romanova", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2024, "design": "case-series", "n": 17, "nField": "reported", "population": "adolescents aged 10-17 with pilonidal disease", "intervention": "pilonidal disease laser treatment (PiLaT)", "comparator": "none (compared to literature outcomes in adults)", "primaryOutcome": "complication and recurrence rates after treatment", "result": "24% complication rate and 18% recurrence rate, with favorable scar scores", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a small, retrospective case series without a comparison group, so it cannot show whether laser treatment works better than other options.", "directness": "direct", "limitations": "Retrospective design, small sample size, no control group, single-center experience.", "followUp": "24.5 ± 16.8 months", "plainFinding": "Some complications and recurrences seen.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39141158/", "sourceText": "BACKGROUND: Pilonidal disease (PD) is an acquired condition related to hair-induced mechanical forces on the skin surface of the intergluteal cleft, with subsequent abscess formation with or without a concomitant draining sinus (pit). While surgical management currently is the mainstay of treatment, pilonidal disease laser treatment (PiLaT) has recently been recognized as a promising treatment option for non-inflammatory diseases. Nonetheless, there is a paucity of available data on adolescent pilonidal disease laser treatment (a-PiLaT). METHODS: We describe our preliminary experience with PiLaT performed in adolescents aged 10-17 years at our tertiary paediatric surgical hospital from 2019 to 2023. Data on perioperative characteristics and clinical outcomes at follow-up were retrospectively analysed. RESULTS: A total of 17 consecutive patients (n = 12 female, 71%) underwent a-PiLaT. At the time of treatment, the patients' mean age and body mass index were 13.6 ± 1.6 years and 25.3 ± 5.6 kg m-2, respectively. The mean operative time was 21.5 ± 10.4 min, whereas the mean follow-up period was 24.5 ± 16.8 months, with a complication rate of 24% (n = 4) and recurrence rate of 18% (n = 3). With respect to postsurgical scar assessment, the mean Patient and Observer Scar Assessment Scale scores (score range 6-60, with higher scores indicating worse outcome) were 14.2 ± 6.5 (patients' evaluation) and 11.4 ± 4.7 (observers' evaluation). CONCLUSION: The a-PiLaT represents a novel approach for managing PD in adolescents. Our preliminary data on the outcomes of a small series of patients with pilonidal sinuses after a-PiLaT indicated complication and recurrence rates comparable to those reported in the literature for adults. This new minimally invasive technique has great potential and is therefore worthy of further research on a larger population.", "provenance": [ { "field": "n", "quote": "A total of 17 consecutive patients (n = 12 female, 71%) underwent a-PiLaT." }, { "field": "population", "quote": "PiLaT performed in adolescents aged 10-17 years" }, { "field": "intervention", "quote": "pilonidal disease laser treatment (PiLaT)" }, { "field": "comparator", "quote": "complication and recurrence rates comparable to those reported in the literature for adults" }, { "field": "primaryOutcome", "quote": "complication rate of 24% (n = 4) and recurrence rate of 18% (n = 3)" }, { "field": "result", "quote": "complication rate of 24% (n = 4) and recurrence rate of 18% (n = 3)" }, { "field": "followUp", "quote": "the mean follow-up period was 24.5 ± 16.8 months" } ] }, { "id": "pmid:39141128", "pmid": "39141128", "doi": "10.1007/s00383-024-05818-6", "nctId": null, "pmcid": null, "title": "Standardized pilonidal protocol as rescue therapy for excision-refractory pilonidal disease", "firstAuthor": "Emengo", "multipleAuthors": true, "journal": "Pediatr Surg Int", "year": 2024, "design": "case-series", "n": 34, "nField": "reported", "population": "patients with pilonidal disease that came back or did not heal after one or more prior surgeries", "intervention": "standardized minimally invasive protocol with wound care, regular manual or laser hair removal, and selective debridement/pit opening", "comparator": "patients' own prior surgical treatment history, no separate control group", "primaryOutcome": "complete resolution of pilonidal symptoms and recurrence rate", "result": "all patients achieved complete healing after a median of 52 days, with 14.7% recurring", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a single-arm study of a small group of patients with no comparison group, so it can't show whether laser hair removal itself caused the improvement.", "directness": "indirect", "limitations": "No control group; combines laser epilation with wound care and selective surgical debridement so the effect of laser alone can't be separated; small sample of patients with especially severe, treatment-resistant disease.", "followUp": "median follow-up 405 days", "plainFinding": "Combined protocol healed resistant cysts", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39141128/", "sourceText": "PURPOSE: Severe pilonidal diseases have refractory symptoms despite multiple surgeries and optimal therapy remains unclear. We hypothesized that standardized minimally invasive protocol could be an effective rescue treatment. METHODS: We prospectively collected data from symptomatic patients who underwent ≥ 1 pilonidal excision prior to presentation at our clinic 2019-2023. We treated these patients with standardized protocol incorporating local wound care, regular manual/laser epilation, and selective debridement/pit trephination. RESULTS: We treated 34 refractory patients (23 males) with median follow-up 405 days. Median age of first symptoms was 17.1 years; presentation to our clinic 20.0 years. Prior to our clinic, 27 received one surgery (cleft lift-2, excision no closure-1, excision primary closure-18, wound vac after excision-3, excision flap closure-3); 7 had two surgeries (excision without closure + cleft lift-1, primary closure after excision twice-3, flap closure after excision twice-2, excision primary closure + excision without closure-1). We treated all patients with regular epilation ± local wound care. 14 (41%) underwent trephination ± debridement. All patients achieved complete resolution after median 52 days. Five (14.7%) recurred and were treated with trephination + debridement-2 or wound care alone-3. Symptom length had no correlation with resolution time, skin type, hair amount. CONCLUSIONS: Standardized minimally invasive protocol requiring only selective surgical intervention can treat refractory pilonidal disease with low recurrence rate.", "provenance": [ { "field": "n", "quote": "We treated 34 refractory patients (23 males) with median follow-up 405 days." }, { "field": "population", "quote": "symptomatic patients who underwent ≥ 1 pilonidal excision prior to presentation at our clinic" }, { "field": "intervention", "quote": "standardized protocol incorporating local wound care, regular manual/laser epilation, and selective debridement/pit trephination" }, { "field": "comparator", "quote": "Prior to our clinic, 27 received one surgery" }, { "field": "primaryOutcome", "quote": "All patients achieved complete resolution after median 52 days." }, { "field": "result", "quote": "All patients achieved complete resolution after median 52 days. Five (14.7%) recurred" }, { "field": "followUp", "quote": "median follow-up 405 days" } ] }, { "id": "pmid:39140695", "pmid": "39140695", "doi": "10.1097/SLE.0000000000001316", "nctId": null, "pmcid": null, "title": "Results of Laser-assisted Closure (SiLaC) Surgery in Pilonidal Sinus Disease: Factors Associated With Success", "firstAuthor": "Yildirim", "multipleAuthors": true, "journal": "Surg Laparosc Endosc Percutan Tech", "year": 2024, "design": "retrospective", "n": 64, "nField": "reported", "population": "adults with pilonidal sinus disease treated at a tertiary care hospital", "intervention": "laser-assisted closure of the pilonidal sinus tract (SiLaC)", "comparator": "none (single group, outcomes compared between recovered and non-recovered patients)", "primaryOutcome": "recovery (healing) and recurrence after treatment", "result": "85.9% recovery rate, 14% complication rate; higher BMI and more advanced disease linked to lower success", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this was a retrospective single-group study without a comparison treatment, so it cannot show if laser worked better than other options.", "directness": "direct", "limitations": "retrospective design, no control group, single center, moderate sample size", "followUp": "17.0±8.06 months (range: 3 to 36)", "plainFinding": "Most patients healed with laser treatment", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39140695/", "sourceText": "BACKGROUND: Pilonidal sinus treatment with sinus laser-assisted closure (SiLaC) method has produced promising results in a limited number of studies conducted in recent years. We aimed to examine the efficacy and safety of this method in a tertiary care training hospital to reveal the factors affecting failure and to share our first experiences. METHODS: All adult patients treated with this procedure between March 2020 and December 2023 were included in the study. Demographic and clinical data, complications, and recurrence rates of the patients were compared. Univariate analysis was performed between recovered and non-recovered patients to find the factors influencing successful treatment. Logistic regression analysis was performed using significant factors in the single variable analysis. RESULTS: The study cohort consisted of 64 patients. The mean follow-up period was 17.0±8.06 months (range: 3 to 36), and the mean time for return to work was 2.4±2.78 days (range: 0 to 14). Our recovery rate was 85.9%. The complication rate was 14%, and the majority (50%) were wound infections. High BMI and advanced disease were significant factors for recurrence in the comparison of patients with successful and unsuccessful treatment ( P <0.01 and 0.013, respectively). The same situation persisted in multivariate analysis ( P =0.026, 95% CI: 1.36-7.81, and P =0.004, 95% CI: 1.36-1.78, respectively). In the ROC Curve analysis for BMI, the cutoff point was 29 (sensitivity: 66.9%, specificity: 77.4%, AUC 0.809). Other parameters were not significant ( P >0.05). CONCLUSIONS: The SiLaC procedure may be the treatment of choice for pilonidal sinus disease as a safe and effective method with mild complications and reasonable recurrence rates. The success rate decreased in obese patients and patients with advanced disease.", "provenance": [ { "field": "n", "quote": "The study cohort consisted of 64 patients." }, { "field": "population", "quote": "All adult patients treated with this procedure between March 2020 and December 2023 were included in the study." }, { "field": "intervention", "quote": "Pilonidal sinus treatment with sinus laser-assisted closure (SiLaC) method" }, { "field": "comparator", "quote": "Univariate analysis was performed between recovered and non-recovered patients to find the factors influencing successful treatment." }, { "field": "primaryOutcome", "quote": "recurrence rates of the patients were compared" }, { "field": "result", "quote": "Our recovery rate was 85.9%. The complication rate was 14%" }, { "field": "followUp", "quote": "The mean follow-up period was 17.0±8.06 months (range: 3 to 36)" } ] }, { "id": "pmid:39036233", "pmid": "39036233", "doi": "10.7759/cureus.62807", "nctId": null, "pmcid": "PMC11260285", "title": "Preventing Pilonidal Sinus Recurrence With Laser Hair Epilation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials", "firstAuthor": "Muscat", "multipleAuthors": true, "journal": "Cureus", "year": 2024, "design": "meta-analysis", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus disease", "intervention": "laser hair epilation", "comparator": "alternative approaches to prevent recurrence", "primaryOutcome": "rate of pilonidal sinus recurrence after at least one year", "result": "significant reduction in recurrence with laser hair epilation (odds ratio 0.319, 95% CI 0.160–0.636, p=0.0001)", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "It pools only three randomized trials, so the result is promising but based on limited data.", "directness": "direct", "limitations": "Only three RCTs met inclusion criteria, and the authors call for further high-quality trials to determine ideal timing and frequency of sessions.", "followUp": "a minimum of one year", "plainFinding": "Fewer sinus recurrences with laser hair removal.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39036233/", "sourceText": "Pilonidal sinus disease (PSD) is a common condition associated with significant morbidity and healthcare costs. High recurrence rates still pose a considerable challenge in managing PSD, with no universally accepted guideline in place to guide management. Laser hair epilation offers a way to reduce recurrence rates with reports within the current literature demonstrating positive outcomes compared to alternative approaches. This review was conducted by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement standards. The primary outcome measure was the recurrence rate of PSD at a minimum of one year following laser hair epilation. The electronic databases of MEDLINE, EMBASE, CINAHL, Google Scholar, PubMed, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched. OpenMeta Analyst (Brown University School of Public Health, Providence, RI) software was used for data synthesis. Three randomized controlled trials met the inclusion criteria with laser hair epilation treatments offering a significant reduction in PSD recurrence rates on odds ratio analysis: 0.319 ( 0.160, 0.636), P-value = 0.0001. Secondary outcomes involving patient disability days, caregiver disability days, health-related quality-of-life (HRQOL) scores, healthcare satisfaction scores, and perceived stigma were discussed qualitatively. The authors offer a decisive recommendation in favor of laser hair epilation in PSD; however, they recommend further high-quality trials to investigate the ideal timing and frequency of laser hair epilation sessions.", "provenance": [ { "field": "population", "quote": "Pilonidal sinus disease (PSD) is a common condition associated with significant morbidity and healthcare costs." }, { "field": "intervention", "quote": "Laser hair epilation offers a way to reduce recurrence rates" }, { "field": "comparator", "quote": "compared to alternative approaches" }, { "field": "primaryOutcome", "quote": "The primary outcome measure was the recurrence rate of PSD at a minimum of one year following laser hair epilation." }, { "field": "result", "quote": "laser hair epilation treatments offering a significant reduction in PSD recurrence rates on odds ratio analysis: 0.319 ( 0.160, 0.636), P-value = 0.0001." }, { "field": "followUp", "quote": "at a minimum of one year following laser hair epilation" }, { "field": "limitations", "quote": "they recommend further high-quality trials to investigate the ideal timing and frequency of laser hair epilation sessions." } ] }, { "id": "pmid:38933617", "pmid": "38933617", "doi": "10.7759/cureus.61141", "nctId": null, "pmcid": "PMC11200306", "title": "Advancements and Innovations in the Surgical Management of Sacrococcygeal Pilonidal Sinus: A Comprehensive Review", "firstAuthor": "Dhole", "multipleAuthors": true, "journal": "Cureus", "year": 2024, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with sacrococcygeal pilonidal sinus (a chronic cyst/tract near the tailbone)", "intervention": "laser therapy and other surgical innovations for pilonidal sinus", "comparator": "conventional excision and flap surgical procedures", "primaryOutcome": "postoperative pain, recurrence rates, and patient satisfaction", "result": "abstract does not give specific outcome data, only notes laser therapy as a recent advancement discussed in the review", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a general narrative review that summarizes topics without reporting specific data, numbers, or comparative results for laser therapy.", "directness": "indirect", "limitations": "no original data, no numbers, no comparative results reported, recommends further prospective studies", "followUp": "", "plainFinding": "No specific results reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38933617/", "sourceText": "Sacrococcygeal pilonidal sinus (SPS) is a common condition characterized by the formation of a sinus tract or cavity in the sacrococcygeal region, often containing hair and debris. Surgical management plays a crucial role in its treatment due to its chronic and recurrent nature. This comprehensive review explores the advancements and innovations in the surgical management of SPS. The review begins with an overview of the historical perspective, anatomy, and pathophysiology of the condition, followed by a discussion of current surgical techniques, including conventional excision, flap procedures, and minimally invasive approaches. Recent advancements, such as laser therapy, radiological guidance techniques, and robotic-assisted surgery, are also examined. The key findings from outcomes research are summarized, including postoperative pain management, recurrence rates, and patient satisfaction. The implications for clinical practice are discussed, emphasizing the importance of staying updated on the latest surgical techniques and adopting a personalized approach to treatment. Recommendations for future research are provided, highlighting the need for prospective studies comparing different surgical techniques, as well as research focusing on minimally invasive approaches and predictive models for recurrence risk. Collaboration among researchers, clinicians, and industry partners is essential to drive innovation and improve outcomes for patients with SPS.", "provenance": [ { "field": "population", "quote": "Sacrococcygeal pilonidal sinus (SPS) is a common condition characterized by the formation of a sinus tract or cavity in the sacrococcygeal region, often containing hair and debris." }, { "field": "intervention", "quote": "Recent advancements, such as laser therapy, radiological guidance techniques, and robotic-assisted surgery, are also examined." }, { "field": "comparator", "quote": "current surgical techniques, including conventional excision, flap procedures, and minimally invasive approaches" }, { "field": "primaryOutcome", "quote": "The key findings from outcomes research are summarized, including postoperative pain management, recurrence rates, and patient satisfaction." }, { "field": "result", "quote": "Recent advancements, such as laser therapy, radiological guidance techniques, and robotic-assisted surgery, are also examined." } ] }, { "id": "pmid:38849230", "pmid": "38849230", "doi": "10.1016/j.jviscsurg.2024.03.007", "nctId": null, "pmcid": null, "title": "SiLaT: A paradigm shift in the treatment of pilonidal disease?", "firstAuthor": "Draullette", "multipleAuthors": true, "journal": "J Visc Surg", "year": 2024, "design": "case-series", "n": 111, "nField": "reported", "population": "adults with primary or recurrent pilonidal sinus disease", "intervention": "sinus laser therapy (SiLaT)", "comparator": "none", "primaryOutcome": "healing of the pilonidal sinus (closure of skin openings without leakage or abscess)", "result": "78.4% of patients healed, with median healing time of 20 days and high patient satisfaction", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a single-group case series without a comparison group, so it cannot show whether laser worked better than other treatments.", "directness": "direct", "limitations": "No control group, single-center study, variable follow-up time, no predictive factors identified on multivariate analysis", "followUp": "339.2 (± 221.4) days", "plainFinding": "Most healed, high satisfaction.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38849230/", "sourceText": "BACKGROUND: Pilonidal disease (PD) is a common condition for which the global incidence is increasing. Surgery is the currently preferred approach to treatment but there is a growing interest in new minimally invasive techniques, such as sinus laser therapy (SiLaT). AIM: Our primary objective was to assess the efficacy of SiLaT for the treatment of pilonidal disease. The secondary objectives were to evaluate morbidity and patient satisfaction and identify predictive factors of success. METHODS: All adult patients, who underwent SiLaT in our department for a primary or recurrent pilonidal sinus from June 1, 2018, to December 31, 2020, were included in the study. Healing was defined as the closure of cutaneous orifices and the absence of seepage or abscesses. RESULTS: In total, 111 consecutive patients, for whom the male/female sex ratio was 2.1 and the mean age 28.8 (± 9.4) years, were included in this study. Eighteen (16.2%) patients had already undergone prior surgery for PD. The mean follow-up was 339.2 (± 221.4) days. A healing rate of 78.4% was observed, with a median time to healing of 20.0 days (15.0-30.0). The median time to return to usual activities was three days (1-7). The only postoperative complication was bleeding, which occurred for two patients (1.8%). Eighty-two patients (88.2%) reported being \"very satisfied\" with the treatment. Multivariate analysis showed no predictive factors for healing among the studied variables. CONCLUSION: SiLaT is an efficient and safe procedure for the treatment of PD, with a high level of patient satisfaction. It will now be necessary to position it within the therapeutic algorithm.", "provenance": [ { "field": "n", "quote": "111 consecutive patients" }, { "field": "population", "quote": "All adult patients, who underwent SiLaT in our department for a primary or recurrent pilonidal sinus" }, { "field": "intervention", "quote": "sinus laser therapy (SiLaT)" }, { "field": "comparator", "quote": "Surgery is the currently preferred approach to treatment but there is a growing interest in new minimally invasive techniques, such as sinus laser therapy (SiLaT)." }, { "field": "primaryOutcome", "quote": "Healing was defined as the closure of cutaneous orifices and the absence of seepage or abscesses." }, { "field": "result", "quote": "A healing rate of 78.4% was observed, with a median time to healing of 20.0 days (15.0-30.0)." }, { "field": "result", "quote": "Eighty-two patients (88.2%) reported being \"very satisfied\" with the treatment." }, { "field": "followUp", "quote": "The mean follow-up was 339.2 (± 221.4) days." } ] }, { "id": "pmid:38800275", "pmid": "38800275", "doi": "10.7759/cureus.59092", "nctId": null, "pmcid": "PMC11128316", "title": "Laser Ablation of Pilonidal Sinus in a Patient With Hemophilia Type A: A Case Report and Review of the Literature", "firstAuthor": "Basendowah", "multipleAuthors": true, "journal": "Cureus", "year": 2024, "design": "case-series", "n": 1, "nField": "reported", "population": "young man with hemophilia type A and recurrent pilonidal sinus", "intervention": "laser ablation of the pilonidal sinus", "comparator": "none", "primaryOutcome": "successful treatment without complications", "result": "the pilonidal sinus was successfully treated with laser ablation and no complications occurred", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show whether laser treatment works in general.", "directness": "indirect", "limitations": "Single case report in a patient with a rare bleeding disorder, no comparison group, no long-term follow-up data given.", "followUp": "", "plainFinding": "Worked in one case.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38800275/", "sourceText": "Pilonidal sinus (PNS) is a common occurrence in young men. It is often caused by blockage of the sebaceous glands in the hair follicles in the sacrococcygeal area. Hemophilia type A is a hemorrhagic disorder caused by a deficiency of factor VIII. It presents with excessive bleeding, either spontaneously or secondary to trauma. The mainstay of treatment for PNS is often excision of the sinus; however, recently, laser ablation has started to be commonly used. In this article, we present a case of a young man with hemophilia A presenting with recurrent PNS successfully managed with laser ablation with no complications.", "provenance": [ { "field": "population", "quote": "a young man with hemophilia A presenting with recurrent PNS" }, { "field": "intervention", "quote": "successfully managed with laser ablation with no complications" }, { "field": "comparator", "quote": "The mainstay of treatment for PNS is often excision of the sinus; however, recently, laser ablation has started to be commonly used." }, { "field": "primaryOutcome", "quote": "successfully managed with laser ablation with no complications" }, { "field": "result", "quote": "successfully managed with laser ablation with no complications" }, { "field": "n", "quote": "we present a case of a young man" } ] }, { "id": "pmid:38704463", "pmid": "38704463", "doi": "10.1007/s13304-024-01848-w", "nctId": null, "pmcid": null, "title": "Minimum energy laser pilonidotomy (MELPi): a multicenter study of a novel method in pilonidal disease", "firstAuthor": "Paz Oliveira", "multipleAuthors": true, "journal": "Updates Surg", "year": 2024, "design": "retrospective", "n": 47, "nField": "reported", "population": "patients with pilonidal disease", "intervention": "minimal energy laser pilonidotomy (MELPi)", "comparator": "none (single-arm, no comparison group)", "primaryOutcome": "healing, recurrence, pain, and complications after laser treatment", "result": "Fast healing (median 15 days), low pain, low complication rate, but recurrence in 10% of cases", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective study without a comparison group, so it can't show laser treatment is better than other options.", "directness": "direct", "limitations": "Retrospective design, no control/comparator group, multicenter variability", "followUp": "12 months", "plainFinding": "Fast healing, low pain, some recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38704463/", "sourceText": "Laser surgery, a minimally invasive procedure for the definitive approach to pilonidal disease (PD), has been frequently studied in recent years. This study aims to describe a new pilonidotomy method using minimal laser energy and evaluate its initial results. This is a retrospective multicenter study. We included 47 consecutive patients who underwent 50 \"minimal energy pilonidotomies (MELPi)\" between 2019 and 2023 in four centers in Brazil. Age, BMI, gender, smoking, diabetes, Guner classification, duration of illness, energy, hospitalization time, complications, recurrence, wound closure, pain, and return to activities were analyzed. The median age was 27; 61.7% were men, and 38.3% were women. The median BMI was 25.7. Smoking was evident in 14.9%, and diabetes in 2.1%. The average duration of the disease was 3 years. Most operations (36%) were performed on stage R disease. The median hospitalization time was 6 h, and the median healing time was 15 days. The average energy used in procedures was 433 J. The median postoperative pain was 2. Secretion occurred in 14% on the 60th day. Complications (cellulitis) occurred in 4% of cases. The median time to return to work was 7 days. The average following time was 12 months; recurrence occurred in 5 (10%)-in 3 patients, a second MELPi procedure was performed and was effective. MELPi shows promising initial results: low pain, low complication rates, and a fast activity return. It is a good option in recidivate cases and can be done more than once if necessary.", "provenance": [ { "field": "n", "quote": "We included 47 consecutive patients who underwent 50 \"minimal energy pilonidotomies (MELPi)\"" }, { "field": "population", "quote": "patients who underwent 50 \"minimal energy pilonidotomies (MELPi)\" between 2019 and 2023 in four centers in Brazil" }, { "field": "intervention", "quote": "minimal energy pilonidotomies (MELPi)" }, { "field": "comparator", "quote": "This is a retrospective multicenter study." }, { "field": "primaryOutcome", "quote": "complications, recurrence, wound closure, pain, and return to activities were analyzed" }, { "field": "result", "quote": "The median healing time was 15 days." }, { "field": "result", "quote": "The median postoperative pain was 2." }, { "field": "result", "quote": "recurrence occurred in 5 (10%)-in 3 patients, a second MELPi procedure was performed and was effective." } ] }, { "id": "pmid:38530042", "pmid": "38530042", "doi": "10.1177/03000605241236057", "nctId": null, "pmcid": "PMC10967004", "title": "Efficacy of laser obliteration with limited excision of pilonidal sinus", "firstAuthor": "Gratiashvili", "multipleAuthors": true, "journal": "J Int Med Res", "year": 2024, "design": "prospective-cohort", "n": 152, "nField": "reported", "population": "patients with chronic pilonidal sinus disease", "intervention": "laser obliteration with limited excision (LOLE)", "comparator": "wide excision (WE) of the pilonidal sinus", "primaryOutcome": "complete wound healing, recurrence, and complication rate", "result": "Faster wound healing with laser (6.5 vs 14.5 weeks), similar healing rates, no significant difference in recurrence", "resultDirection": "mixed", "quality": "low", "qualityWhy": "Non-randomized observational study comparing two surgical techniques, so differences could be due to other factors, not just the treatment.", "directness": "direct", "limitations": "Not randomized; abstract does not report blinding or statistical details beyond healing time and recurrence.", "followUp": "", "plainFinding": "Faster healing, similar recurrence rates.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38530042/", "sourceText": "OBJECTIVE: This study was performed to compare the effectiveness of laser obliteration with limited excision (LOLE) versus wide excision (WE) of the pilonidal sinus. METHODS: A prospective, cross-sectional observational study of 152 patients with chronic pilonidal sinus disease was performed from September 2019 to September 2022. Of the 152 patients, 76 underwent LOLE and 76 underwent WE. The main evaluation criteria were complete wound healing, recurrence, and the complication rate. RESULTS: Complete healing was achieved in 74 (97.4%) patients in the LOLE group and 76 (100%) patients in the WE group. The duration of wound healing was significantly shorter in the LOLE group than in the WE group (6.5 ± 2.4 vs. 14.5 ± 2.6 weeks, respectively). Recurrence developed in six (7.9%) patients in the LOLE group and one (1.3%) patient in the WE group, with no significant difference. CONCLUSION: According to our study and the data available in the literature, laser surgery should be included in the guidelines for the treatment and management of pilonidal disease.", "provenance": [ { "field": "n", "quote": "A prospective, cross-sectional observational study of 152 patients with chronic pilonidal sinus disease" }, { "field": "population", "quote": "152 patients with chronic pilonidal sinus disease" }, { "field": "intervention", "quote": "laser obliteration with limited excision (LOLE)" }, { "field": "comparator", "quote": "wide excision (WE) of the pilonidal sinus" }, { "field": "primaryOutcome", "quote": "The main evaluation criteria were complete wound healing, recurrence, and the complication rate." }, { "field": "result", "quote": "The duration of wound healing was significantly shorter in the LOLE group than in the WE group (6.5 ± 2.4 vs. 14.5 ± 2.6 weeks, respectively)." }, { "field": "result", "quote": "Recurrence developed in six (7.9%) patients in the LOLE group and one (1.3%) patient in the WE group, with no significant difference." } ] }, { "id": "pmid:38348985", "pmid": "38348985", "doi": "10.5604/01.3001.0053.9305", "nctId": null, "pmcid": null, "title": "Sequential, ultrasound-guided, minimally invasive pit-picking procedure with Nd:YAG laser epilation treatment for pilonidal disease", "firstAuthor": "Czarnecki", "multipleAuthors": true, "journal": "Pol Przegl Chir", "year": 2023, "design": "case-series", "n": 52, "nField": "reported", "population": "adolescent patients with pilonidal disease", "intervention": "minimally invasive pit-picking procedure combined with Nd:YAG laser epilation, guided by ultrasound", "comparator": "none", "primaryOutcome": "being symptom-free from pilonidal disease at follow-up", "result": "96% of patients were symptom-free, with only 4% experiencing relapse", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a small, retrospective study with no comparison group, so it cannot show whether the treatment works better than other options.", "directness": "direct", "limitations": "Retrospective design, no control group, and only 52 of 147 treated patients were included in the analysis.", "followUp": "1-year follow-up", "plainFinding": "Most patients symptom-free after treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38348985/", "sourceText": "<b><br>Aim:</b> The aim of this retrospective study was to evaluate our treatment for pilonidal disease in adolescent patients, which uses ultrasonography, minimally invasive pit-picking, and Nd:YAG laser therapy.</br> <b><br>Material and methods:</b> We included 52 of 147 patients treated between June 2017 and December 2020. The patients underwent pit-picking procedures and 6-10 Nd:YAG treatments. The remnants of the cysts were removed by laser therapy, which provided easy epilation. Each patient underwent multiple ultrasound examinations during the therapy to uncover any potential newly formed asymptomatic sinuses. When such issues were identified, the pit-picking procedure was repeated on those sinuses.</br> <b><br>Results:</b> A total of 52 patients were included in this study with a 1-year follow-up following the procedure. There were 49 symptom-free patients (96%). One patient underwent surgery in another hospital because of a recurrence and 1 had a pilonidal disease relapse (4%). In the follow-up period, asymptomatic cysts were found in 2 other patients by ultrasound examination. They were all treated with a pit-picking procedure in the outpatient department with good results.</br> <b><br>Conclusions:</b> Combining sequentially repeated pit-picking procedures and Nd:YAG laser therapy is an effective treatment method for adolescent pilonidal disease. Simultaneous Nd:YAG laser therapy enables efficacious epilation of the intergluteal cleft. Repeatable ultrasonography examinations allow for early diagnosis of possible pilonidal sinus relapse.</br>.", "provenance": [ { "field": "population", "quote": "evaluate our treatment for pilonidal disease in adolescent patients" }, { "field": "intervention", "quote": "uses ultrasonography, minimally invasive pit-picking, and Nd:YAG laser therapy" }, { "field": "comparator", "quote": "We included 52 of 147 patients treated between June 2017 and December 2020." }, { "field": "primaryOutcome", "quote": "There were 49 symptom-free patients (96%)." }, { "field": "result", "quote": "There were 49 symptom-free patients (96%). One patient underwent surgery in another hospital because of a recurrence and 1 had a pilonidal disease relapse (4%)." }, { "field": "n", "quote": "A total of 52 patients were included in this study with a 1-year follow-up following the procedure." }, { "field": "followUp", "quote": "A total of 52 patients were included in this study with a 1-year follow-up following the procedure." } ] }, { "id": "pmid:38291247", "pmid": "38291247", "doi": "10.1007/s10103-024-03993-5", "nctId": null, "pmcid": "PMC10827894", "title": "Comparison of laser ablation, simple excision, and flap reconstruction in the treatment of pilonidal sinus disease", "firstAuthor": "Tyrväinen", "multipleAuthors": true, "journal": "Lasers Med Sci", "year": 2024, "design": "retrospective", "n": 278, "nField": "reported", "population": "patients who had surgery for pilonidal sinus disease", "intervention": "laser ablation", "comparator": "simple excision with direct closure, or excision with flap reconstruction", "primaryOutcome": "eventless healing, residual disease, recurrence, complications, and re-operations", "result": "Laser had similar eventless healing rates but more residual disease and fewer complications than the other two surgical methods", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective comparison with very different follow-up times between groups, which makes the outcomes hard to compare fairly.", "directness": "direct", "limitations": "Retrospective design; unequal and widely varying follow-up times between groups (15.4 months for laser vs 87.6 months for flap).", "followUp": "15.4 ± 7.6 months in the laser group", "plainFinding": "More leftover disease, fewer complications.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38291247/", "sourceText": "Pilonidal sinus disease (PSD) is a common condition that typically affects young adults. PSD may cause significant morbidity due to its chronic nature and tendency to recur. Laser ablation has recently shown promising results in the treatment of PSD, but comparative studies are sparse. We aimed to compare laser ablation with two conventional treatment options: simple excision with direct closure and excision with flap reconstruction. This retrospective study material included patients who underwent PSD surgery in the plastic surgery department of a single academic teaching hospital. Patients were divided into three groups based on the operation technique: laser group, direct closure group, and flap group. Preoperative and postoperative data were compared between the groups including patient characteristics, residual disease, recurrent disease, complications, and re-operations. Among the 278 patients, 66 underwent laser treatment, 134 excision with direct closure, and 78 excision with flap closure. The follow-up time ranged from 15.4 ± 7.6 months in the laser group to 87.6 ± 29.3 months in the flap group. Eventless healing occurred in 67.7% of the patients in the laser group, 66.4% of the patients in the direct closure group, and 56.4% of the patients in the flap group. There was significantly more residual disease in the laser group whereas significantly more complications were found in the direct closure and flap groups. The advantages of laser treatment include fast postoperative recovery and reduced risk of complications.", "provenance": [ { "field": "n", "quote": "Among the 278 patients, 66 underwent laser treatment, 134 excision with direct closure, and 78 excision with flap closure." }, { "field": "population", "quote": "This retrospective study material included patients who underwent PSD surgery in the plastic surgery department of a single academic teaching hospital." }, { "field": "intervention", "quote": "Laser ablation has recently shown promising results in the treatment of PSD" }, { "field": "comparator", "quote": "We aimed to compare laser ablation with two conventional treatment options: simple excision with direct closure and excision with flap reconstruction." }, { "field": "primaryOutcome", "quote": "Preoperative and postoperative data were compared between the groups including patient characteristics, residual disease, recurrent disease, complications, and re-operations." }, { "field": "result", "quote": "There was significantly more residual disease in the laser group whereas significantly more complications were found in the direct closure and flap groups." }, { "field": "followUp", "quote": "The follow-up time ranged from 15.4 ± 7.6 months in the laser group to 87.6 ± 29.3 months in the flap group." } ] }, { "id": "pmid:38093161", "pmid": "38093161", "doi": "10.1007/s10151-023-02897-w", "nctId": null, "pmcid": null, "title": "Surgical outcomes of minimally invasive trephine surgery for pilonidal sinus disease with and without laser therapy: a comparative study", "firstAuthor": "Horesh", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2023, "design": "retrospective", "n": 221, "nField": "reported", "population": "adults with pilonidal sinus disease", "intervention": "trephine (pit excision) surgery combined with laser therapy", "comparator": "trephine surgery alone, without laser therapy", "primaryOutcome": "recurrence of the pilonidal sinus within 1 year", "result": "adding laser therapy led to a much lower recurrence rate than surgery alone (8.2% vs 32.9%)", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective, single-center study with matching to reduce bias, but it is not a randomized trial so the result could still be affected by unmeasured factors.", "directness": "direct", "limitations": "Retrospective design, unmatched groups differed in age and surgeon experience, and the authors call for prospective studies to confirm the findings.", "followUp": "1-year", "plainFinding": "Fewer recurrences when laser added to surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38093161/", "sourceText": "BACKGROUND: Over the last decades, novel therapeutic options have emerged for the surgical treatment of pilonidal sinus disease (PSD). The aim of this study was to evaluate the outcomes of trephine/pit excision surgery with or without laser therapy in patients with PSD. METHODS: A retrospective cohort study was conducted at a large tertiary medical center, including all adult patients with PNS who underwent trephine surgery with/without laser therapy between 2016 and 2021[AUTHORS TO INSERT MONTH]. Propensity score matching was used to address confounding factors, and the primary outcome was the 1-year recurrence rate. RESULTS: The study included 221 patients with PSD, with a mean age of 23.73 years (87.7% male). In the unmatched cohort (130 trephine surgery alone, 91 trephine surgery + laser therapy), significant differences were observed in mean age (23 vs. 25 years; p < 0.01)[AUTHROS TO USE MEDIAN PLUS RANGE OR ADD SD] and surgeons' experience (p = 0.014). Propensity score matching was applied to overcome confounding factors, resulting in a matched cohort including 73 patients in each group. The addition of laser therapy demonstrated a significantly lower recurrence rate (8.2% vs. 32.9%; p < 0.001) compared to pit excision without laser therapy. Logistic regression analysis showed that the addition of laser was significantly associated with a lower risk for recurrence (OR 0.23; 95% CI 0.089-0.633; p < 0.01). CONCLUSION: The incorporation of laser therapy along with trephine/pit excision surgery significantly reduces the recurrence rate in patients with PNS. Further prospective studies are needed to confirm our findings.", "provenance": [ { "field": "population", "quote": "all adult patients with PNS who underwent trephine surgery" }, { "field": "intervention", "quote": "trephine surgery + laser therapy" }, { "field": "comparator", "quote": "trephine surgery alone" }, { "field": "primaryOutcome", "quote": "the primary outcome was the 1-year recurrence rate" }, { "field": "result", "quote": "significantly lower recurrence rate (8.2% vs. 32.9%; p < 0.001) compared to pit excision without laser therapy" }, { "field": "n", "quote": "The study included 221 patients with PSD" } ] }, { "id": "pmid:37971129", "pmid": "37971129", "doi": "10.1590/1806-9282.20230740", "nctId": null, "pmcid": "PMC10645176", "title": "Use of the laser in the pilonidal sinus alone or in combination with phenol", "firstAuthor": "Şahin", "multipleAuthors": true, "journal": "Rev Assoc Med Bras (1992)", "year": 2023, "design": "retrospective", "n": 46, "nField": "reported", "population": "patients with pilonidal sinus disease treated in a general surgery clinic", "intervention": "laser treatment alone or laser treatment combined with phenol", "comparator": "laser alone versus laser plus phenol", "primaryOutcome": "recurrence rate and complete healing of the pilonidal sinus", "result": "Laser-phenol group had slightly lower recurrence and higher healing rates than laser alone, but the difference was not statistically significant", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "It is a small retrospective study without randomization or a non-laser comparison group, so results carry limited weight.", "directness": "indirect", "limitations": "Retrospective design; no comparison to a non-laser treatment; small sample size; difference between groups not statistically significant.", "followUp": "fourth month", "plainFinding": "No clear benefit of adding phenol to laser.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37971129/", "sourceText": "OBJECTIVE: We investigated the effectiveness of combining laser treatment with phenol in the management of pilonidal sinus. METHODS: We present here a retrospective analysis of patients with pilonidal sinus disease who were treated in the general surgery clinic of the Balikesir University Hospital between October 2019 and February 2022. RESULTS: Recurrence was observed in three patients (13.6%) in the laser treatment group and one patient (4.8%) in the laser-phenol treatment group after the fourth month. Notably, 22 (91.7%) patients in the laser treatment group and 21 (95.5%) patients in the laser-phenol treatment group had complete healing. CONCLUSION: Although not statistically significant, the laser-phenol treatment group exhibited a lower recurrence rate and a higher complete healing rate.", "provenance": [ { "field": "population", "quote": "patients with pilonidal sinus disease who were treated in the general surgery clinic of the Balikesir University Hospital between October 2019 and February 2022" }, { "field": "intervention", "quote": "combining laser treatment with phenol in the management of pilonidal sinus" }, { "field": "comparator", "quote": "laser treatment group and one patient (4.8%) in the laser-phenol treatment group" }, { "field": "primaryOutcome", "quote": "Recurrence was observed in three patients (13.6%) in the laser treatment group and one patient (4.8%) in the laser-phenol treatment group after the fourth month" }, { "field": "result", "quote": "Although not statistically significant, the laser-phenol treatment group exhibited a lower recurrence rate and a higher complete healing rate." }, { "field": "n", "quote": "22 (91.7%) patients in the laser treatment group and 21 (95.5%) patients in the laser-phenol treatment group had complete healing" } ] }, { "id": "pmid:37938854", "pmid": "37938854", "doi": "10.1001/jamasurg.2023.5526", "nctId": null, "pmcid": "PMC10633416", "title": "Laser Epilation as an Adjunct to Standard Care in Reducing Pilonidal Disease Recurrence in Adolescents and Young Adults: A Randomized Clinical Trial", "firstAuthor": "Minneci", "multipleAuthors": true, "journal": "JAMA Surg", "year": 2024, "design": "rct", "n": 302, "nField": "reported", "population": "adolescents and young adults aged 11 to 21 with pilonidal disease", "intervention": "laser hair removal plus standard care (hygiene and depilation)", "comparator": "standard care alone (hygiene and depilation)", "primaryOutcome": "rate of pilonidal disease recurrence at 1 year", "result": "recurrence was significantly lower with laser epilation added to standard care", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "it was a randomized trial but many patients were lost to follow-up, especially in the laser group, which could bias the results.", "directness": "direct", "limitations": "One-year follow-up was available for only 63.6% of the laser group and 88.7% of the standard care group, so a substantial portion of participants were lost to follow-up.", "followUp": "1-year follow-up", "plainFinding": "Fewer recurrences with laser hair removal added.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37938854/", "sourceText": "IMPORTANCE: Recurrence continues to be a significant challenge in the treatment and management of pilonidal disease. OBJECTIVE: To compare the effectiveness of laser epilation (LE) as an adjunct to standard care vs standard care alone in preventing recurrence of pilonidal disease in adolescents and young adults. DESIGN, SETTING, AND PARTICIPANTS: This was a single-institution, randomized clinical trial with 1-year follow-up conducted from September 2017 to September 2022. Patients aged 11 to 21 years with pilonidal disease were recruited from a single tertiary children's hospital. INTERVENTION: LE and standard care (improved hygiene and mechanical or chemical depilation) or standard care alone. MAIN OUTCOMES AND MEASURES: The primary outcome was the rate of recurrence of pilonidal disease at 1 year. Secondary outcomes assessed during the 1-year follow-up included disability days, health-related quality of life (HRQOL), health care satisfaction, disease-related attitudes and perceived stigma, and rates of procedures, surgical excisions, and postoperative complications. RESULTS: A total of 302 participants (median [IQR] age, 17 [15-18] years; 157 male [56.1%]) with pilonidal disease were enrolled; 151 participants were randomly assigned to each intervention group. One-year follow-up was available for 96 patients (63.6%) in the LE group and 134 (88.7%) in the standard care group. The proportion of patients who experienced a recurrence within 1 year was significantly lower in the LE treatment arm than in the standard care arm (-23.2%; 95% CI, -33.2 to -13.1; P < .001). Over 1 year, there were no differences between groups in either patient or caregiver disability days, or patient- or caregiver-reported HRQOL, health care satisfaction, or perceived stigma at any time point. The LE group had significantly higher Child Attitude Toward Illness Scores (CATIS) at 6 months (median [IQR], 3.8 [3.4-4.2] vs 3.6 [3.2-4.1]; P = .01). There were no differences between groups in disease-related health care utilization, disease-related procedures, or postoperative complications. CONCLUSIONS AND RELEVANCE: LE as an adjunct to standard care significantly reduced 1-year recurrence rates of pilonidal disease compared with standard care alone. These results provide further evidence that LE is safe and well tolerated in patients with pilonidal disease. LE should be considered a standard treatment modality for patients with pilonidal disease and should be available as an initial treatment option or adjunct treatment modality for all eligible patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03276065.", "provenance": [ { "field": "n", "quote": "A total of 302 participants" }, { "field": "population", "quote": "Patients aged 11 to 21 years with pilonidal disease were recruited from a single tertiary children's hospital." }, { "field": "intervention", "quote": "LE and standard care (improved hygiene and mechanical or chemical depilation)" }, { "field": "comparator", "quote": "standard care alone" }, { "field": "primaryOutcome", "quote": "The primary outcome was the rate of recurrence of pilonidal disease at 1 year." }, { "field": "result", "quote": "The proportion of patients who experienced a recurrence within 1 year was significantly lower in the LE treatment arm than in the standard care arm (-23.2%; 95% CI, -33.2 to -13.1; P < .001)." }, { "field": "followUp", "quote": "1-year follow-up" }, { "field": "limitations", "quote": "One-year follow-up was available for 96 patients (63.6%) in the LE group and 134 (88.7%) in the standard care group." } ] }, { "id": "pmid:37930579", "pmid": "37930579", "doi": "10.1007/s10151-023-02870-7", "nctId": null, "pmcid": "PMC10638206", "title": "Non-excisional techniques for the treatment of intergluteal pilonidal sinus disease: a systematic review", "firstAuthor": "Huurman", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2023, "design": "systematic-review", "n": 8100, "nField": "reported", "population": "patients with pilonidal sinus disease (a cyst/tunnel near the tailbone)", "intervention": "non-excisional techniques including pit picking with or without laser or phenol, unroofing, endoscopic treatment, and gelatin matrix application", "comparator": "comparison between different non-excisional techniques, including with vs without treatment of the inner sinus lining, and primary vs recurrent disease", "primaryOutcome": "recurrence rates, healing rates, complication rates, wound healing time and return to daily activities", "result": "Techniques that treated the inner lining (including laser) had worse recurrence rates, varying from 0 to 29%, than pit picking alone", "resultDirection": "mixed", "quality": "low", "qualityWhy": "It pools very different techniques and studies of varying quality without a formal statistical meta-analysis, so the comparisons are not strong evidence.", "directness": "indirect", "limitations": "Abstract does not report study designs included (likely mostly observational), does not give statistical comparisons, and recurrence rates depend heavily on follow-up time which varied across studies.", "followUp": "", "plainFinding": "Laser not clearly better, more recurrence", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37930579/", "sourceText": "Non-excisional techniques for pilonidal sinus disease (PSD) have gained popularity over the last years. The aim of this study was to review short and long-term outcomes for non-excisional techniques with special focus on the additive effect of treatment of the inner lining of the sinus cavity and the difference between primary and recurrent PSD. A systematic search was conducted in Embase, Medline, Web of Science Core Collection, Cochrane and Google Scholar databases for studies on non-excisional techniques for PSD including pit picking techniques with or without additional laser or phenol treatment, unroofing, endoscopic techniques and thrombin gelatin matrix application. Outcomes were recurrence rates, healing rates, complication rates, wound healing times and time taken to return to daily activities. In total, 31 studies comprising 8100 patients were included. Non-excisional techniques had overall healing rates ranging from 67 to 100%. Recurrence rates for pit picking, unroofing and gelatin matrix application varied from 0 to 16% depending on the follow-up time. Recurrence rates after additional laser, phenol and endoscopic techniques varied from 0 to 29%. Complication rates ranged from 0 to 16%, and the wound healing time was between three and forty-seven days. The return to daily activities varied from one to nine days. Non-excisional techniques are associated with fast recovery and low morbidity but recurrence rates are high. Techniques that attempt to additionally treat the inner lining of the sinus have worse recurrence rates than pit picking alone. Recurrence rates do not differ between primary and recurrent disease.", "provenance": [ { "field": "n", "quote": "31 studies comprising 8100 patients were included" }, { "field": "population", "quote": "Non-excisional techniques for pilonidal sinus disease (PSD)" }, { "field": "intervention", "quote": "pit picking techniques with or without additional laser or phenol treatment, unroofing, endoscopic techniques and thrombin gelatin matrix application" }, { "field": "comparator", "quote": "difference between primary and recurrent PSD" }, { "field": "primaryOutcome", "quote": "Outcomes were recurrence rates, healing rates, complication rates, wound healing times and time taken to return to daily activities" }, { "field": "result", "quote": "Techniques that attempt to additionally treat the inner lining of the sinus have worse recurrence rates than pit picking alone." }, { "field": "result", "quote": "Recurrence rates after additional laser, phenol and endoscopic techniques varied from 0 to 29%." } ] }, { "id": "pmid:37494954", "pmid": "37494954", "doi": "10.1055/s-0043-1771224", "nctId": null, "pmcid": null, "title": "Outcomes of Pediatric Endoscopic Pilonidal Sinus Treatment: A Systematic Review", "firstAuthor": "Mentessidou", "multipleAuthors": true, "journal": "Eur J Pediatr Surg", "year": 2024, "design": "systematic-review", "n": 320, "nField": "reported", "population": "Children and teens (under 18) with pilonidal sinus disease", "intervention": "Endoscopic pilonidal sinus treatment (PEPSiT), with some patients also receiving perioperative or postoperative laser hair removal", "comparator": "Within PEPSiT: fistuloscope vs. cystoscope, and different wound care methods (regular shaving, creams, light pulse, or laser) after surgery", "primaryOutcome": "Treatment success (healing) and recurrence of the sinus", "result": "Laser hair removal (perioperative or postoperative) did not significantly change success or recurrence rates compared to other hair removal methods", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "This is a pooled review of mostly small, non-randomized studies, and the laser comparison was just one of several subgroup analyses with a borderline p-value (p=0.06) that didn't reach significance.", "directness": "indirect", "limitations": "The review itself notes a lack of comparison with conventional surgical techniques, and the laser-specific finding was a secondary comparison within a broader review of an endoscopic surgical procedure, not a dedicated study of laser treatment itself.", "followUp": "13.5 months", "plainFinding": "No added benefit from laser hair removal.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37494954/", "sourceText": "Treatment of pilonidal sinus disease with conventional excision techniques is associated with recurrence up to 20 to 30% (primary closure) or with prolonged healing that might last months (closure by secondary intention). Endoscopic pilonidal sinus treatment (EPSiT) is gaining increasing popularity. This systematic review aims to summarize and evaluate the reported outcomes of pediatric EPSiT (PEPSiT) to date. Systematic search was performed for all studies on PEPSiT in patients younger than 18 years, pertaining to demographics, technique, and outcomes. Fisher's test was used to assess the associations between success/recurrence rates and different approaches (fistuloscope vs. cystoscope, different wound care protocols). A total of 320 patients (9 studies, 2018-2022) with a weighted mean age of 15.7 years and follow-up duration of 13.5 months were included. PEPSiT was successful in 290 patients (90.9%) with weighted mean time to healing of 4.1 weeks. Recurrence was reported in 29 patients (9.1%) with weighted mean time to recurrence of 4.6 months. Outcomes were not significantly altered by the use of fistuloscope versus pediatric cystoscope (p = 1.0), or with perioperative laser epilation (p = 0.06), or postoperative regular shaving, depilatory creams, light pulse, or laser (p = 0.31). The weighted mean operative time was 38 minutes and hospital stay was 16 hours. Summary of available evidence confirms that PEPSiT is safe and effective. Added to its noninvasiveness, PEPSiT's pooled outcomes appear superior to those of numerous conventional techniques. Comparison with conventional techniques, particularly off-midline flap and semi-closure procedures, is, however, lacking. The superiority of PEPSiT needs to be confirmed in future comparative studies, including cost-benefit analysis.", "provenance": [ { "field": "n", "quote": "A total of 320 patients (9 studies, 2018-2022) with a weighted mean age of 15.7 years and follow-up duration of 13.5 months were included." }, { "field": "population", "quote": "all studies on PEPSiT in patients younger than 18 years" }, { "field": "intervention", "quote": "Endoscopic pilonidal sinus treatment (EPSiT) is gaining increasing popularity." }, { "field": "intervention", "quote": "with perioperative laser epilation" }, { "field": "comparator", "quote": "fistuloscope vs. cystoscope" }, { "field": "comparator", "quote": "postoperative regular shaving, depilatory creams, light pulse, or laser" }, { "field": "primaryOutcome", "quote": "PEPSiT was successful in 290 patients (90.9%) with weighted mean time to healing of 4.1 weeks. Recurrence was reported in 29 patients (9.1%)" }, { "field": "result", "quote": "Outcomes were not significantly altered by the use of fistuloscope versus pediatric cystoscope (p = 1.0), or with perioperative laser epilation (p = 0.06), or postoperative regular shaving, depilatory creams, light pulse, or laser (p = 0.31)." }, { "field": "followUp", "quote": "follow-up duration of 13.5 months" } ] }, { "id": "pmid:37440707", "pmid": "37440707", "doi": "10.24875/CIRU.22000461", "nctId": null, "pmcid": null, "title": "Comparison of the effectiveness of laser and crystallized phenol in the treatment of sacrococcygeal pilonidal sinus", "firstAuthor": "Taşkin", "multipleAuthors": true, "journal": "Cir Cir", "year": 2023, "design": "rct", "n": 80, "nField": "reported", "population": "patients with sacrococcygeal pilonidal sinus disease", "intervention": "laser treatment", "comparator": "crystallized phenol treatment", "primaryOutcome": "recurrence, patient satisfaction, pain, and complications", "result": "No difference in recurrence or satisfaction; laser had less pain and fewer complications but took longer", "resultDirection": "mixed", "quality": "low", "qualityWhy": "Small trial of 80 patients with no mention of blinding or long-term follow-up details, limiting confidence in results.", "directness": "direct", "limitations": "Abstract does not report blinding, follow-up duration, or how recurrence was measured over time.", "followUp": "", "plainFinding": "Less pain, similar recurrence rates.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37440707/", "sourceText": "BACKGROUND: The aim of this study was to compare the effectiveness of crystallized phenol and laser in the treatment of sacrococcygeal pilonidal sinus (SPS) disease. RESULTS: A total of 80 patients (40 crystallized phenol, 40 laser) were included in the study. The procedure time was significantly shorter in the crystallized phenol group than in the laser group (543 and 837 s, p < 0.001). While there was no significant difference in recurrence and patient satisfaction between the groups (p > 0.05), the visual pain scale pain score and post-procedural complications were significantly lower in the laser group (p < 0.05). There was no significant difference between the number of sinuses and recurrence, bleeding, pain, and patient satisfaction (p > 0.05). CONCLUSIONS: Crystallized phenol and laser used in the treatment of SPS disease have a low recurrence and similar long-term patient satisfaction. However, laser treatment has fewer intraoperative complications and post-operative pain severity than crystallized phenol.", "provenance": [ { "field": "n", "quote": "A total of 80 patients (40 crystallized phenol, 40 laser) were included in the study." }, { "field": "population", "quote": "treatment of sacrococcygeal pilonidal sinus (SPS) disease" }, { "field": "intervention", "quote": "40 laser" }, { "field": "comparator", "quote": "40 crystallized phenol" }, { "field": "primaryOutcome", "quote": "there was no significant difference in recurrence and patient satisfaction between the groups (p > 0.05), the visual pain scale pain score and post-procedural complications were significantly lower in the laser group (p < 0.05)" }, { "field": "result", "quote": "While there was no significant difference in recurrence and patient satisfaction between the groups (p > 0.05), the visual pain scale pain score and post-procedural complications were significantly lower in the laser group (p < 0.05)." } ] }, { "id": "pmid:37438655", "pmid": "37438655", "doi": "10.1007/s13304-023-01578-5", "nctId": null, "pmcid": null, "title": "Laser technology in proctological diseases: is it really the wave of the future?", "firstAuthor": "Solari", "multipleAuthors": true, "journal": "Updates Surg", "year": 2023, "design": "systematic-review", "n": 55, "nField": "reported", "population": "Patients with proctological conditions including pilonidal sinus disease", "intervention": "Laser treatment (SiLaT - sinus laser treatment) for pilonidal sinus disease", "comparator": "Traditional surgical techniques for pilonidal sinus disease", "primaryOutcome": "Perioperative pain, hospital stay, and primary healing rate", "result": "Less pain and shorter hospital stay, but lower primary healing rate than traditional surgery", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a scoping review with no meta-analysis, highly varied studies, and no randomized trials for the pilonidal laser technique.", "directness": "direct", "limitations": "Meta-analysis of data was not performed because of heterogeneity of study designs and outcome measures; available data on SiLaT is very limited, and no randomized trials are published to date.", "followUp": "", "plainFinding": "Less pain, but lower healing rate.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37438655/", "sourceText": "Different types of lasers have been applied for various proctological conditions. We discuss about published articles regarding the application of lasers, with concern about evidence-based use of these techniques and technologies. We performed a literature search about laser treatments for proctological conditions. 55 studies were included for the final revision. Meta-analysis of data was not performed because of heterogeneity of study designs and outcome measures. A scoping review was performed. Laser treatments for hemorrhoids require a shorter operative time and show less postoperative pain and bleeding compared to conventional hemorrhoidectomy, but are more expensive. Studies are heterogeneous in design, endpoints, postoperative assessment, length of follow-up and outcome measures. Only 3 RCTs are available and only three studies evaluate long-term outcomes. FiLaC (fistula laser closure) was initially described in 2011 for the treatment of anal fistula. In the published studies the reported healing rates vary between 20 and 82%, and the ideal indication is yet to be defined. Studies with long-term follow-up are lacking. SiLaT (sinus laser treatment) applied the technology used for FiLaC to the treatment of pilonidal sinus disease. This technique had less perioperative pain and shorter hospital stay, but a lower primary healing rate when compared to traditional techniques. Available data is very limited, and no randomized trials are published to date. Laser assisted techniques are a viable, minimally invasive, but expensive option for the treatment of several proctological conditions. Further researches are needed to assess if patients could benefit of their use, and for what indication.", "provenance": [ { "field": "population", "quote": "SiLaT (sinus laser treatment) applied the technology used for FiLaC to the treatment of pilonidal sinus disease." }, { "field": "intervention", "quote": "SiLaT (sinus laser treatment)" }, { "field": "comparator", "quote": "when compared to traditional techniques" }, { "field": "primaryOutcome", "quote": "This technique had less perioperative pain and shorter hospital stay, but a lower primary healing rate when compared to traditional techniques." }, { "field": "result", "quote": "This technique had less perioperative pain and shorter hospital stay, but a lower primary healing rate when compared to traditional techniques." }, { "field": "n", "quote": "55 studies were included for the final revision." }, { "field": "limitations", "quote": "Meta-analysis of data was not performed because of heterogeneity of study designs and outcome measures." }, { "field": "limitations", "quote": "Available data is very limited, and no randomized trials are published to date." } ] }, { "id": "pmid:37356014", "pmid": "37356014", "doi": "10.1007/s10151-023-02831-0", "nctId": null, "pmcid": null, "title": "Short- and mid-term results of diode laser treatment in pilonidal sinus disease and the role of endoscopic camera use on outcomes", "firstAuthor": "Bilgin", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2023, "design": "retrospective", "n": 106, "nField": "reported", "population": "patients with pilonidal sinus disease", "intervention": "diode laser treatment (1470-nm), with or without endoscopic camera use", "comparator": "use of endoscopic camera versus no camera use during laser treatment", "primaryOutcome": "postoperative pain, recovery time, complications, patient satisfaction, and recurrence", "result": "87.8% completely recovered, mean recovery 27.4 days, 11.0% recurrence, 99.0% satisfaction; camera use made no difference to outcomes", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective study without a comparison group to standard surgery, so it cannot show laser works better than other treatments.", "directness": "direct", "limitations": "Data were analyzed retrospectively", "followUp": "minimum of 1 year", "plainFinding": "Good recovery and low recurrence with laser.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37356014/", "sourceText": "PURPOSE: Nowadays, surgical treatment of pilonidal sinus disease (PSD) with novel techniques is a topic of interest since conventional methods are associated with longer return to daily life and higher complication and recurrence rates. Recently, use of laser as a minimally invasive approach has become popular in the surgical treatment of PSD. In this study, we analyze the short- and mid-term results after laser treatment and the effect of endoscopic camera use on outcomes. METHODS: A total of 106 patients with PSD who underwent laser treatment between November 2017 and September 2021 were included in this study. All patients were treated with a 1470-nm diode laser. Endoscopic camera was used in 73 patients and results of these were compared with those in whom camera was not used. Follow-up period was determined as a minimum of 1 year. Data were analyzed retrospectively. RESULTS: There were 80 (75%) male and 26 female patients. The median age was 26 (range 13-50) years. On the first postoperative day, 26 (26.5%) patients did not have any pain and 42(42.8%) patients reported low-grade pain. The mean time to return to daily life was 4.5 ± 5.5 (median 2, range 1-30) days. The complication rate was 10.4%. Eighty-six (87.8%) patients completely recovered and the mean complete recovery time was 27.4 ± 15.9 days. The patient satisfaction rate was 99.0%. The recurrence rate was 11.0%. Neither history of previous surgery nor abscess was associated with recurrence. Use of an endoscopic camera had no effect on postoperative pain, complete recovery, complications, patient satisfaction, and recurrence (p < 0.05). CONCLUSION: Laser treatment for PSD is a promising approach with the advantages of less postoperative pain, early return to daily life, high patient satisfaction, and acceptable complication and recurrence rates. Nevertheless, further studies are needed to investigate the role of endoscopic camera use in this procedure since its possible advantages could not be clarified.", "provenance": [ { "field": "n", "quote": "A total of 106 patients with PSD who underwent laser treatment" }, { "field": "population", "quote": "106 patients with PSD who underwent laser treatment between November 2017 and September 2021" }, { "field": "intervention", "quote": "All patients were treated with a 1470-nm diode laser." }, { "field": "comparator", "quote": "Endoscopic camera was used in 73 patients and results of these were compared with those in whom camera was not used." }, { "field": "primaryOutcome", "quote": "we analyze the short- and mid-term results after laser treatment and the effect of endoscopic camera use on outcomes" }, { "field": "result", "quote": "Eighty-six (87.8%) patients completely recovered and the mean complete recovery time was 27.4 ± 15.9 days. The patient satisfaction rate was 99.0%. The recurrence rate was 11.0%." }, { "field": "result", "quote": "Use of an endoscopic camera had no effect on postoperative pain, complete recovery, complications, patient satisfaction, and recurrence" }, { "field": "followUp", "quote": "Follow-up period was determined as a minimum of 1 year." }, { "field": "limitations", "quote": "Data were analyzed retrospectively." } ] }, { "id": "pmid:37289117", "pmid": "37289117", "doi": null, "nctId": null, "pmcid": null, "title": "[Pilonidal disease: The revolution in minimally invasive surgery]", "firstAuthor": "Spindler", "multipleAuthors": true, "journal": "Rev Prat", "year": 2023, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "People with pilonidal disease (a common skin condition near the tailbone)", "intervention": "Minimally invasive techniques, including endoscopic and laser treatment", "comparator": "Standard surgical excision (lay-open excision, primary repair, or flap procedures)", "primaryOutcome": "Failure/recurrence rate and complications after treatment", "result": "Failure rates of less than 10% at 1 year, with few and minor complications", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a narrative review summarizing other studies, not new controlled data, and the authors themselves say better quality studies with longer follow-up are needed.", "directness": "indirect", "limitations": "Abstract groups endoscopic and laser techniques together rather than reporting laser results alone, and explicitly states results need confirmation by better studies with longer follow-up.", "followUp": "1 year", "plainFinding": "Promising early results, but evidence still weak.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37289117/", "sourceText": "THE REVOLUTION IN MINIMALLY INVASIVE SURGERY. Pilonidal disease is a common suppurative condition and affects 0.7% of the population. Surgical excision is the standard treatment. In France, the most common procedure is lay-open excision with healing by secondary intention. This procedure has low recurrence rates, but involves daily nursing care, long healing time and long period of sick-leave. Excision and primary repair or flap-based procedures are good alternatives to reduce these negative aspects but they expose to higher recurrence rates than excision with healing by secondary intention. The goal of minimally invasive techniques is to eradicate the suppuration, obtain healing as quick as possible, and limit the morbidity as much as possible. Old minimally invasive approaches such as phenolization or pit-picking are associated with low morbidity but with higher recurrence rates. Currently, new minimally invasive techniques are being developed. Endoscopic and laser treatment of pilonidal disease have shown promising results, with failure rates of less than 10% at 1 year, few complications and low morbidity. Complications are rare and minor. However, these interesting results need to be confirmed by better quality studies with longer follow-up.", "provenance": [ { "field": "population", "quote": "Pilonidal disease is a common suppurative condition and affects 0.7% of the population." }, { "field": "intervention", "quote": "Endoscopic and laser treatment of pilonidal disease have shown promising results" }, { "field": "comparator", "quote": "Surgical excision is the standard treatment." }, { "field": "primaryOutcome", "quote": "failure rates of less than 10% at 1 year, few complications and low morbidity" }, { "field": "result", "quote": "Endoscopic and laser treatment of pilonidal disease have shown promising results, with failure rates of less than 10% at 1 year, few complications and low morbidity." } ] }, { "id": "pmid:37256592", "pmid": "37256592", "doi": "10.1001/jamasurg.2023.0373", "nctId": null, "pmcid": null, "title": "Management of Pilonidal Disease: A Review", "firstAuthor": "Gil", "multipleAuthors": true, "journal": "JAMA Surg", "year": 2023, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal disease (a skin condition near the tailbone)", "intervention": "laser or intense pulse light hair removal, used alone or alongside other treatments", "comparator": "other treatments for pilonidal disease, including surgery and conservative care", "primaryOutcome": "disease recurrence and treatment-related complications", "result": "abstract does not report specific outcome data for laser treatment; it is only listed as one of several options", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a general narrative review that does not present actual study results or data comparing laser treatment to other options", "directness": "indirect", "limitations": "the abstract itself states the overall evidence is limited by study quality, inconsistent disease definitions, and variable outcome reporting across studies", "followUp": "", "plainFinding": "No specific result reported for laser.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37256592/", "sourceText": "IMPORTANCE: The management of pilonidal disease continues to be a challenge due to high rates of recurrence and treatment-associated morbidity. OBSERVATIONS: There is a heterogeneous repertoire of treatment modalities used in the management of pilonidal disease and wide practice variation among clinicians. Available treatment options vary considerably in their level of invasiveness, associated morbidity and disability, risks of complications, and effectiveness at preventing disease recurrence. Conservative nonoperative management strategies, including persistent improved hygiene, depilation, and lifestyle modification, focus on disease prevention and minimization of disease activity. Epilation techniques using both laser and intense pulse light therapy are also used as primary and adjunct treatment modalities. Other nonoperative treatment modalities include phenol and fibrin injection to promote closure of pilonidal sinuses. The traditional operative management strategy for pilonidal disease involves excision of affected tissue paired with a variety of closure types including primary midline closure, primary off-midline closure techniques (ie, Karydakis flap, Limberg flap, Bascom cleft lift), and healing by secondary intention. There has been a recent shift toward more minimally invasive operative approaches including sinusectomy (ie, trephination or Gips procedure) and endoscopic approaches. Overall, the current evidence supporting the different treatment options is limited by study quality with inconsistent characterization of disease severity and use of variable definitions and reporting of treatment-associated outcomes across studies. CONCLUSIONS AND RELEVANCE: Pilonidal disease is associated with significant physical and psychosocial morbidity. Optimal treatments will minimize disease and treatment-associated morbidity. There is a need for standardization of definitions used to characterize pilonidal disease and its outcomes to develop evidence-based treatment algorithms.", "provenance": [ { "field": "intervention", "quote": "Epilation techniques using both laser and intense pulse light therapy are also used as primary and adjunct treatment modalities." }, { "field": "population", "quote": "the management of pilonidal disease" }, { "field": "result", "quote": "Overall, the current evidence supporting the different treatment options is limited by study quality with inconsistent characterization of disease severity and use of variable definitions and reporting of treatment-associated outcomes across studies." }, { "field": "primaryOutcome", "quote": "high rates of recurrence and treatment-associated morbidity" }, { "field": "comparator", "quote": "primary midline closure, primary off-midline closure techniques (ie, Karydakis flap, Limberg flap, Bascom cleft lift), and healing by secondary intention" } ] }, { "id": "pmid:37204472", "pmid": "37204472", "doi": "10.1007/s10103-023-03788-0", "nctId": null, "pmcid": null, "title": "Laser ablation: a unique and beneficial therapeutic option for pilonidal sinus? And the potential for further innovation-a review", "firstAuthor": "Ganduboina", "multipleAuthors": true, "journal": "Lasers Med Sci", "year": 2023, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "People with pilonidal sinus disease", "intervention": "Laser ablation techniques (e.g., SiLaC, SiLaT, PiLaT, LEPSiT) using diode or Nd:YAG lasers", "comparator": "Conventional surgical methods for pilonidal sinus disease", "primaryOutcome": "Healing rate, recurrence, complications, and patient satisfaction", "result": "Laser ablation showed higher healing rates, lower recurrence, less post-op morbidity, and higher patient satisfaction compared to conventional surgery", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a literature review without pooled statistics or formal quality assessment, so the findings are less reliable than a controlled trial.", "directness": "direct", "limitations": "The abstract does not describe study quality, bias assessment, or statistical pooling, and calls for long-term prospective comparative studies.", "followUp": "", "plainFinding": "Better healing, fewer complications with laser", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37204472/", "sourceText": "Laser has revolutionized the medical field, broadening the diagnostic and therapeutic spectrum, with diode (630-980 nm) and Nd:YAG (1064 nm) lasers being the common choices in ablation procedures. Laser ablation in pilonidal sinus disease is a new minimally invasive technique with good treatment efficacy, low post-op morbidity, and shorter recovery periods following employment. This review study aimed to provide information on the use of lasers in pilonidal sinus disease and their effectiveness compared to other conventional methods. The articles considered were obtained by performing a literature search in PubMed, Cochrane, and Google Scholar, and 44 articles were included in this study. Techniques like sinus laser-assisted closure (SiLaC), sinus laser therapy (SiLaT), pilonidal sinus laser treatment (PiLaT), and laser-assisted endoscopic pilonidal sinus treatment (LEPSiT) were included and reviewed. Diode laser was most commonly used, with local anesthesia preferred over spinal or general anesthesia. The highest healing rate was observed with Nd:YAG laser and the SiLaT technique. Recurrence was low, particularly in patients who underwent multiple procedures. On reviewing the published literature, laser ablation procedures showed lower morbidity and post-op complications. Patient satisfaction was higher, and the overall cost was found to be lower with minimally invasive techniques. Long-term prospective studies comparing lasers with other surgical techniques would help us ascertain the future treatment modality of pilonidal sinus disease.", "provenance": [ { "field": "population", "quote": "pilonidal sinus disease" }, { "field": "intervention", "quote": "Techniques like sinus laser-assisted closure (SiLaC), sinus laser therapy (SiLaT), pilonidal sinus laser treatment (PiLaT), and laser-assisted endoscopic pilonidal sinus treatment (LEPSiT) were included and reviewed." }, { "field": "comparator", "quote": "effectiveness compared to other conventional methods" }, { "field": "primaryOutcome", "quote": "The highest healing rate was observed with Nd:YAG laser and the SiLaT technique. Recurrence was low, particularly in patients who underwent multiple procedures." }, { "field": "result", "quote": "laser ablation procedures showed lower morbidity and post-op complications. Patient satisfaction was higher, and the overall cost was found to be lower with minimally invasive techniques." } ] }, { "id": "pmid:37064557", "pmid": "37064557", "doi": "10.5114/wiitm.2022.124206", "nctId": null, "pmcid": "PMC10091928", "title": "Endoscopic pilonidal sinus treatment (EPSIT) versus sinus laser therapy (SiLaT) for sacrococcygeal pilonidal sinus", "firstAuthor": "Ersavas", "multipleAuthors": true, "journal": "Wideochir Inne Tech Maloinwazyjne", "year": 2023, "design": "retrospective", "n": 73, "nField": "reported", "population": "patients with pilonidal sinus (sacrococcygeal pilonidal sinus disease)", "intervention": "sinus laser therapy (SiLaT)", "comparator": "endoscopic pilonidal sinus treatment (EPSIT)", "primaryOutcome": "complications, wound healing time, return to activity, and recurrence", "result": "Wound healing time and return to activity were similar between groups; SiLaT patients needed analgesics for longer; no significant difference in complications or recurrence", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "This was a small retrospective study comparing two surgical techniques without randomization, so it cannot reliably show which treatment is better.", "directness": "direct", "limitations": "Retrospective design, small sample size, no randomization mentioned", "followUp": "", "plainFinding": "Similar healing, more pain relief needed with laser", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37064557/", "sourceText": "INTRODUCTION: New surgical treatment methods are being investigated in sacrococcygeal pilonidal sinus disease. Minimal invasive methods such as endoscopic pilonidal sinus treatment (EPSIT) and sinus laser therapy (SiLaT) have promising results and advantages of laparoscopic surgery. AIM: To compare the efficiency and safety of EPSIT with SiLaT. MATERIAL AND METHODS: Seventy-three patients with pilonidal sinus who had undergone EPSIT or SiLaT within 2 years were evaluated retrospectively. Data of patients' demographics, complications and postoperative course were collected and compared between the two groups. RESULTS: We analyzed seventy-three patients who underwent EPSIT or SiLaT, with a mean age of 23.4 ±8.4 (12-46) years and body mass index (BMI) of 25.5 ±4.5 (18-38) kg/m2. Among them, 36 patients (26 males, ten females) underwent EPSIT and 37 patients (27 males, ten females) underwent SiLaT. Mean operative time was similar for both groups (32.3 ±14.8 vs. 31.0 ±14.8; p = 0.757). Early complications (minimal bleeding) were recorded in 2 patients in the SiLaT group. The duration of analgesic use was significantly lower in the EPSIT group compared to the SiLaT group (1.3 ±0.5 (1-3) vs. 1.9 ±1.1 (1-5); p = 0.005). The mean postoperative time of total wound healing was similar for both groups: 23.6 ±14.7 (12-90) vs. 25.2 ±14.5 (14-90) days (p = 0.385). There was no significant difference in the average time of return to total daily activity (3.4 ±0.9 (2-5) vs. 3.6 ±1.2 (2-7) days, p = 0.679). There were no significant differences between the groups regarding late postoperative complications (recurrence: 7). CONCLUSIONS: Both methods have similar early and late complications. The duration of need for analgesic usage was shorter in EPSIT patients.", "provenance": [ { "field": "n", "quote": "Seventy-three patients with pilonidal sinus who had undergone EPSIT or SiLaT within 2 years were evaluated retrospectively." }, { "field": "population", "quote": "patients with pilonidal sinus" }, { "field": "intervention", "quote": "sinus laser therapy (SiLaT)" }, { "field": "comparator", "quote": "endoscopic pilonidal sinus treatment (EPSIT)" }, { "field": "primaryOutcome", "quote": "Data of patients' demographics, complications and postoperative course were collected and compared between the two groups." }, { "field": "result", "quote": "The duration of analgesic use was significantly lower in the EPSIT group compared to the SiLaT group" }, { "field": "result", "quote": "The mean postoperative time of total wound healing was similar for both groups:" }, { "field": "result", "quote": "There was no significant difference in the average time of return to total daily activity" }, { "field": "result", "quote": "There were no significant differences between the groups regarding late postoperative complications (recurrence: 7)." } ] }, { "id": "pmid:36934004", "pmid": "36934004", "doi": "10.1016/j.jpedsurg.2023.02.054", "nctId": null, "pmcid": null, "title": "Increasing Amount of Hair Reduction using Laser Correlates with Lower Probability of Recurrence in Patients with Pilonidal Disease", "firstAuthor": "Salimi-Jazi", "multipleAuthors": true, "journal": "J Pediatr Surg", "year": 2023, "design": "case-series", "n": 198, "nField": "reported", "population": "patients with pilonidal disease undergoing laser hair removal", "intervention": "laser epilation (hair removal)", "comparator": "different amounts of hair reduction achieved (within same group, no control group)", "primaryOutcome": "recurrence of pilonidal disease", "result": "greater hair reduction from laser was linked to lower recurrence; overall recurrence rate was 6%", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a single-group study without a comparison group, so it cannot prove laser itself caused fewer recurrences.", "directness": "direct", "limitations": "No control group, retrospective-style single arm design, Level IV evidence", "followUp": "217 days", "plainFinding": "More laser hair removal, fewer recurrences.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36934004/", "sourceText": "BACKGROUND: Hair at the gluteal cleft plays a key role in the development and recurrence of pilonidal disease (PD). We hypothesized that more hair reduction achieved using laser could correlate with lower chance of PD recurrence. METHODS: PD patients who underwent laser epilation (LE) were categorized by Fitzpatrick skin type, hair color, and hair thickness. Photos taken at LE sessions were compared to determine hair reduction amount. LE sessions completed prior to the recurrences were recorded. Groups were compared using multivariate T-test. RESULTS: 198 PD patients had mean age 18.1 ± 3.6 years. 21, 156, and 21 patients had skin types 1/2, 3/4, and 5/6, respectively. 47 patients had light- and 151 had dark-colored hair. 29 patients had fine hair, 129 medium, and 40 thick. Median follow-up was 217 days. 95%, 70%, 40%, and 19% of patients reached 20%, 50%, 75%, and 90% hair reduction after mean LE sessions of 2.6, 4.3, 6.6, 7.8 sessions, respectively. To reach 75% hair reduction, patients require a mean of 4.8-6.8 LE sessions, depending on different skin/hair characteristics. PD recurrence rate was 6%. Probability of recurrence after 20%, 50%, 75% hair reduction was decreased by 50%, 78%, 100%, respectively. Dark hair and skin type 5/6 were associated with higher recurrence rates. CONCLUSION: Patients with dark-color and thick hair require more LE sessions to achieve certain degree of hair reduction. Patients with dark hair and skin type 5/6 were more likely to recur; more hair reduction correlated with lower chance of recurrence. LEVEL OF EVIDENCE: Level IV.", "provenance": [ { "field": "n", "quote": "198 PD patients had mean age 18.1 ± 3.6 years." }, { "field": "population", "quote": "PD patients who underwent laser epilation (LE)" }, { "field": "intervention", "quote": "laser epilation (LE)" }, { "field": "comparator", "quote": "more hair reduction achieved using laser could correlate with lower chance of PD recurrence" }, { "field": "primaryOutcome", "quote": "lower chance of PD recurrence" }, { "field": "result", "quote": "Probability of recurrence after 20%, 50%, 75% hair reduction was decreased by 50%, 78%, 100%, respectively." }, { "field": "result", "quote": "PD recurrence rate was 6%." }, { "field": "followUp", "quote": "Median follow-up was 217 days." } ] }, { "id": "pmid:36888964", "pmid": "36888964", "doi": "10.1089/lap.2022.0567", "nctId": null, "pmcid": null, "title": "Outcomes of Laser-Assisted Closure (SiLaC) Surgery for Chronic Pilonidal Sinus Disease", "firstAuthor": "Horesh", "multipleAuthors": true, "journal": "J Laparoendosc Adv Surg Tech A", "year": 2023, "design": "retrospective", "n": 92, "nField": "reported", "population": "patients with chronic pilonidal sinus disease", "intervention": "laser-assisted closure (SiLaC) surgery for pilonidal sinus", "comparator": "none - single group, no comparison treatment", "primaryOutcome": "complete healing rate after surgery", "result": "81.3% of patients achieved complete healing, with about 10% having recurrent or nonhealing disease", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This was a retrospective, single-arm study without a comparison group, so it can't show whether laser treatment works better than other options.", "directness": "direct", "limitations": "Retrospective design, no control group, one patient lost to follow-up, and small single-center sample.", "followUp": "", "plainFinding": "Most healed completely after laser surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36888964/", "sourceText": "Background: Management of pilonidal sinus (PNS) disease has changed notably in the past decade, with the introduction of novel surgical techniques and technological innovation. In this study, we summarized our initial experience with sinus laser-assisted closure (SiLaC) of pilonidal disease. Methods: A retrospective analysis of a prospective database of all patients who underwent minimally invasive surgery combined with laser therapy for PNS between September 2018 and December 2020 was performed. Patients' demographics, clinical and perioperative data, as well postoperative outcomes were recorded and analyzed. Results: A total of 92 patients (86 males, 93.4%) underwent SiLaC surgery for pilonidal sinus disease during the study period. Patients' median age was 22 (range 16-62 years), and 60.8% of them previously underwent abscess drainage due to PNS. SiLaC was performed under local anesthesia in 85.7% of cases (78 patients) with a median energy of 1081 J (range 13-5035 J). One patient was lost to follow-up, leaving 91 patients for final analysis. The primary outcome was complete healing rate, standing at 81.3% (74/91 patients). In 8 patients (8.8%), there was minor incomplete healing that did not require reintervention. Recurrent/nonhealing disease was seen in 9 patients (9.9%), requiring reoperation in 7 patients (8.4%). Of those, 4 patients underwent repeat SiLaC and 3 patients underwent wide excision. Analysis of risk factors for PNS recurrence demonstrated that general anesthesia (P = .02) was associated with increased risk for recurrence along with a trend for increased risk in patients with significant hairiness (P = .078). No differences were seen in age (P = .621), gender (P = .475), median sinus length (P = .397), and energy used (P = .904). Conclusion: Primary healing rate after SiLaC surgery for chronic PNS was >80% in our series. Ten percent of patients did not achieve complete healing but did not require surgery due to lack of symptoms.", "provenance": [ { "field": "n", "quote": "A total of 92 patients (86 males, 93.4%) underwent SiLaC surgery for pilonidal sinus disease during the study period." }, { "field": "population", "quote": "all patients who underwent minimally invasive surgery combined with laser therapy for PNS" }, { "field": "intervention", "quote": "sinus laser-assisted closure (SiLaC) of pilonidal disease" }, { "field": "comparator", "quote": "A retrospective analysis of a prospective database of all patients who underwent minimally invasive surgery combined with laser therapy for PNS" }, { "field": "primaryOutcome", "quote": "The primary outcome was complete healing rate, standing at 81.3% (74/91 patients)." }, { "field": "result", "quote": "Recurrent/nonhealing disease was seen in 9 patients (9.9%), requiring reoperation in 7 patients (8.4%)." } ] }, { "id": "pmid:36877001", "pmid": "36877001", "doi": "10.1097/DCR.0000000000002745", "nctId": null, "pmcid": null, "title": "Laser Ablation of Pilonidal Sinus Disease: A Pilot Study", "firstAuthor": "Williams", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 2023, "design": "case-series", "n": 25, "nField": "reported", "population": "adults and children with pilonidal sinus disease", "intervention": "laser ablation of the pilonidal sinus tract", "comparator": "none (no comparison group)", "primaryOutcome": "safety and feasibility of the procedure, including pain, healing, and satisfaction", "result": "most patients had little pain, quick return to activity, high satisfaction, and most were healed by 6 months", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a small pilot study of 25 patients with no comparison group, so it cannot show whether laser works better than other treatments.", "directness": "direct", "limitations": "small pilot study, no control group, short follow-up, not all patients healed", "followUp": "6 mo", "plainFinding": "Mostly healed, low pain, high satisfaction.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36877001/", "sourceText": "BACKGROUND: Pilonidal disease is classically treated with wide local excision, although a number of minimally invasive approaches are currently under investigation. We aimed to determine the safety and feasibility of laser ablation of pilonidal sinus disease. IMPACT OF INNOVATION: Laser ablation provides a minimally invasive means of obliterating pilonidal sinus tracts without a need for excessive tract dilation. Laser ablation can be performed more than once on the same patient if necessary. TECHNOLOGY MATERIALS AND METHODS: This technique uses the NeoV V1470 Diode Laser (neoLaser Ltd, Caesarea, Israel) with a 2-mm probe. We performed laser ablation in adults and pediatric patients. PRELIMINARY RESULTS: We performed 27 laser ablation procedures in 25 patients, with a median operative time of 30 minutes. Eighty percent of patients reported either no pain or mild pain at the 2-week postoperative visit. The median time to return to work or school was 3 days. Eighty-eight percent of patients reported being satisfied or very satisfied with the procedure at their most recent follow-up (median, 6 mo). Eighty-two percent of patients were healed at 6 months. CONCLUSIONS AND FUTURE DIRECTIONS: Laser ablation of pilonidal disease is safe and feasible. Patients experienced short recovery time and reported low levels of pain and high levels of satisfaction.", "provenance": [ { "field": "n", "quote": "We performed 27 laser ablation procedures in 25 patients" }, { "field": "population", "quote": "We performed laser ablation in adults and pediatric patients." }, { "field": "intervention", "quote": "Laser ablation provides a minimally invasive means of obliterating pilonidal sinus tracts" }, { "field": "comparator", "quote": "We aimed to determine the safety and feasibility of laser ablation of pilonidal sinus disease." }, { "field": "primaryOutcome", "quote": "We aimed to determine the safety and feasibility of laser ablation of pilonidal sinus disease." }, { "field": "result", "quote": "Eighty percent of patients reported either no pain or mild pain at the 2-week postoperative visit." }, { "field": "result", "quote": "Eighty-eight percent of patients reported being satisfied or very satisfied with the procedure at their most recent follow-up (median, 6 mo)." }, { "field": "result", "quote": "Eighty-two percent of patients were healed at 6 months." } ] }, { "id": "pmid:36763170", "pmid": "36763170", "doi": "10.1007/s00384-023-04324-w", "nctId": null, "pmcid": null, "title": "Does minimally invasive laser-assisted treatment of pilonidal sinus disease live up to its expectations: a multi-center study with 226 patients", "firstAuthor": "De Decker", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2023, "design": "retrospective", "n": 226, "nField": "reported", "population": "patients with pilonidal sinus disease treated at three hospitals", "intervention": "laser-assisted treatment of pilonidal sinus", "comparator": "", "primaryOutcome": "overall wound healing after one or more laser procedures", "result": "85.4% overall healing after one or more laser procedures, but 12.8% needed secondary surgery", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective study without a comparison group, so results may not be reliable and could involve bias.", "directness": "direct", "limitations": "Retrospective design, no control group, variable follow-up time, multi-center variability", "followUp": "129 days [7-1120]", "plainFinding": "Mostly works but imperfect healing.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36763170/", "sourceText": "PURPOSE: The minimally invasive character, the possibility to perform under local anesthesia, and the ease to repeat have led to increasing popularity of laser-assisted treatment of pilonidal sinus disease. Hereby, potentially avoiding prolonged need for medical care at home, incapacity to work, and high expenses for patients and society. This retrospective, multi-center study is aimed at evaluating the feasibility of laser-assisted treatment for pilonidal sinus disease. METHODS: The patient population is comprised of all patients undergoing laser-assisted treatment of pilonidal sinus disease at three Belgian hospitals between January 2017 and December 2021. Data were retrospectively collected. The primary endpoint was overall wound healing after one or more laser assisted procedures. RESULTS: A total of 226 patients were included with a mean follow-up time of 129 days [7-1120]. The healing rate after one laser procedure was 78.8%. Some of these patients were healed by a second or third procedure adding up to an overall healing rate of 85.4% after one or more laser procedures. Wound infections were the main postoperative complication (8.0%) of which 5 patients required drainage (2.2%). For 29 patients (12.8%), laser-assisted treatment was insufficient, leading to a secondary operation (drainage, excision, or flap). CONCLUSION: This study shows that laser-assisted treatment is feasible for pilonidal sinus disease. The minimally invasive character of this technique might make up for a higher non-healing rate compared to other techniques like flap repair. However, care must be taken that healing rate might be related to the presentation of the sinus and expectations should be lowered as presumed high healing rates are not always achieved.", "provenance": [ { "field": "n", "quote": "A total of 226 patients were included" }, { "field": "population", "quote": "all patients undergoing laser-assisted treatment of pilonidal sinus disease at three Belgian hospitals between January 2017 and December 2021" }, { "field": "intervention", "quote": "laser-assisted treatment of pilonidal sinus disease" }, { "field": "primaryOutcome", "quote": "The primary endpoint was overall wound healing after one or more laser assisted procedures." }, { "field": "result", "quote": "The healing rate after one laser procedure was 78.8%. Some of these patients were healed by a second or third procedure adding up to an overall healing rate of 85.4% after one or more laser procedures." }, { "field": "result", "quote": "For 29 patients (12.8%), laser-assisted treatment was insufficient, leading to a secondary operation (drainage, excision, or flap)." }, { "field": "followUp", "quote": "mean follow-up time of 129 days [7-1120]" } ] }, { "id": "pmid:36408956", "pmid": "36408956", "doi": null, "nctId": null, "pmcid": null, "title": "Minimally invasive treatment of pilonidal sinus using the new Infinite Ring Fiber. A case series", "firstAuthor": "Liagkos", "multipleAuthors": true, "journal": "Ann Ital Chir", "year": 2023, "design": "case-series", "n": 13, "nField": "reported", "population": "patients with pilonidal cyst with a small fistula opening", "intervention": "laser treatment (NeoV1470 laser with Infinite Ring Fiber) under local anesthesia", "comparator": "none", "primaryOutcome": "successful treatment without complications or disease recurrence", "result": "all patients were successfully treated with no complications or relapse during follow-up", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a tiny uncontrolled case series of only 13 patients, so it cannot reliably show whether the laser works better than other treatments.", "directness": "direct", "limitations": "small sample size, no comparator group, follow-up duration not specified", "followUp": "", "plainFinding": "All treated successfully, no complications.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36408956/", "sourceText": "AIM: In this study, we present a small series of patients with pilonidal cyst, which were treated with NeoV1470 Laser System using Infinite Ring Fiber 600 microns (Mm) (NeoLaser, Caesarea, Israel) (Infinite Ring Fiber - IRF). This fiber is characterized by circular 360-degree heat release, an active 4 mm tip with 1470nm emission and up to now it has been used only for vessel surgery. We are investigating its use in the treatment of pilonidal cyst. MATERIAL AND METHODS: It is a case series study (December 2020 - December 2021) consisting of 13 patients. The choice criterion for the study was that the patient should have at least one fistula opening with maximum size of orifice < 5mm. All patients were treated as day clinic. Surgery was performed with intravenous sedation and local anesthesia using lidocaine. The pulse regime we use was (8w, 3sec, 24 J/per pulse). RESULTS: All the patients had successful treatment. None of the patients treated with the particular fiber had any complications or relapsed disease during the follow up period. DISCUSSION: In the international literature have been described various therapeutic options of pilonidal cyst therapy. The use of use of IRF is another one. CONCLUSIONS: The use of NeoV1470 laser system with IRF at pilonidal cyst therapy appears to be a safe and effective option, with less pain and necrotic detriments. KEY WORDS: Infinite ring fiber, Laser, Pilonidal sinus.", "provenance": [ { "field": "n", "quote": "consisting of 13 patients" }, { "field": "population", "quote": "patients with pilonidal cyst, which were treated with NeoV1470 Laser System" }, { "field": "intervention", "quote": "treated with NeoV1470 Laser System using Infinite Ring Fiber 600 microns (Mm)" }, { "field": "comparator", "quote": "RESULTS: All the patients had successful treatment." }, { "field": "primaryOutcome", "quote": "None of the patients treated with the particular fiber had any complications or relapsed disease during the follow up period." }, { "field": "result", "quote": "All the patients had successful treatment. None of the patients treated with the particular fiber had any complications or relapsed disease during the follow up period." } ] }, { "id": "pmid:36304355", "pmid": "36304355", "doi": "10.7759/cureus.29388", "nctId": null, "pmcid": "PMC9586186", "title": "Outcomes of Sinus Laser Therapy in Sacrococcygeal Pilonidal Sinus Disease: A Single-Center Experience", "firstAuthor": "Zubaidi", "multipleAuthors": true, "journal": "Cureus", "year": 2022, "design": "retrospective", "n": 41, "nField": "reported", "population": "patients with sacrococcygeal pilonidal sinus disease (primary or recurrent)", "intervention": "sinus laser therapy (SiLaT)", "comparator": "none (single-arm, no comparison group)", "primaryOutcome": "wound healing outcomes, recurrence, pain, and patient satisfaction", "result": "Most wounds healed without complications, but about a quarter of patients had the cyst come back", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a small, retrospective single-center study with no comparison group, so it cannot show whether laser works better than other treatments.", "directness": "direct", "limitations": "Retrospective design, no control group, small sample size.", "followUp": "at least six months", "plainFinding": "Mostly healed, but recurrence in a quarter.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36304355/", "sourceText": "Sacrococcygeal pilonidal sinus disease (SPND) is an acquired chronic disease with no precise etiopathogenesis. The morbidity associated with the disease necessitates the implementation of new techniques, such as sinus laser therapy (SiLaT), to improve disease management. However, surgical techniques as of now are preferred as the mainstay mode of treatment. A retrospective study was conducted to evaluate and report the healing outcome of the application of SiLaT on patients with SPND at a tertiary center. All patients who underwent SiLaT for primary or recurrent pilonidal sinus from February 2012 to December 2019 were included in the study and followed up for at least six months. Forty-one participants (37 males (90.2%) and four females (9.8%)) were included. Of the participants, 58.5% presented with chief complaints of painful swelling with mucopurulent discharge. Most of the participants were students (43.9%). SiLaT was the primary intervention for 82.9% of the participants. The mean duration of hospital stays, resumption of regular activity, and complete wound healing by secondary intention were 30±21.5 hours, 18.4±14.3 days, and 6.5±6.6 weeks, respectively. Around 95.1% of wounds healed without complications. The overall recurrence rate was 24.4%, while the recurrence rate with SiLaT being the primary intervention was 11.8%. Only three (7.32%) patients experienced wound infections as postoperative complications. The visual analog scale (VAS) score decreased postoperatively in the first and second weeks to 3.9±3.2 and 1.9±1.9, respectively, and 78.1% of the total patients showed satisfaction post-surgical interventions. The current study showed that the SiLaT technique is a feasible technology with promising results to evolve. Further studies are encouraged.", "provenance": [ { "field": "n", "quote": "Forty-one participants (37 males (90.2%) and four females (9.8%)) were included." }, { "field": "population", "quote": "patients with SPND at a tertiary center" }, { "field": "intervention", "quote": "sinus laser therapy (SiLaT)" }, { "field": "comparator", "quote": "A retrospective study was conducted to evaluate and report the healing outcome of the application of SiLaT on patients with SPND" }, { "field": "primaryOutcome", "quote": "The mean duration of hospital stays, resumption of regular activity, and complete wound healing by secondary intention were 30±21.5 hours, 18.4±14.3 days, and 6.5±6.6 weeks, respectively." }, { "field": "result", "quote": "Around 95.1% of wounds healed without complications. The overall recurrence rate was 24.4%" }, { "field": "followUp", "quote": "followed up for at least six months" } ] }, { "id": "pmid:36102566", "pmid": "36102566", "doi": "10.1097/XCS.0000000000000356", "nctId": null, "pmcid": null, "title": "Resolution of Mild Pilonidal Disease in Adolescents Without Resection", "firstAuthor": "Check", "multipleAuthors": true, "journal": "J Am Coll Surg", "year": 2022, "design": "case-series", "n": 102, "nField": "reported", "population": "adolescents and young adults with mild pilonidal disease", "intervention": "improved hygiene, pit excision under local anesthesia, and laser hair removal", "comparator": "no comparison group; compared to traditional surgical resection in background", "primaryOutcome": "resolution of pilonidal disease", "result": "77 of 78 patients who continued care had their pilonidal disease resolve without surgery", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a single-group case series without a comparison group, and nearly a quarter of patients were lost to follow-up.", "directness": "direct", "limitations": "Twenty-four of 102 patients were lost to follow up; no control group for comparison.", "followUp": "30 ± 19 weeks", "plainFinding": "Resolved without surgery in most patients.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36102566/", "sourceText": "BACKGROUND: Pilonidal disease is a common condition of the gluteal crease, affecting around 1 in 2,000 adolescents and young adults. 1 Traditional options for management of pilonidal disease include improved hygiene with or without hair removal or resection of the nidus. Given a high recurrence rate associated with hygiene alone, nidus resection is often recommended, even for patients with mild pilonidal disease, despite significant postoperative morbidity. We present a consecutive series of patients with mild pilonidal disease managed in a dedicated Pilonidal Care Clinic using an alternate approach directed toward source control: improved hygiene to limit debris in the gluteal crease, excision of midline pilonidal pits under local anesthesia to prevent intrusion of debris with drainage of any nidus present, and laser ablation of midline follicles to prevent new pits from forming. 2. STUDY DESIGN: Data on demographics, disease severity, symptom scoring, treatments provided, and outcome for consecutive new patients presenting to an outpatient pilonidal care clinic with mild disease between August 2017 and September 2020 were analyzed. RESULTS: One hundred two patients presented; their mean age was 16.3 years, 56 (55%) were female, and 42 (41%) had undergone prior nidus incision and drainage. Twenty-four were lost to follow up, and 77 of the 78 who continued care had resolution of their pilonidal disease after a mean of 3 ± 2.5 laser epilations and 1.3 ± 1 pit excisions during 4 ± 2 clinic visits over a treatment duration of 30 ± 19 weeks. CONCLUSION: Mild pilonidal disease may be resolved with improved hygiene, pit excision, and laser epilation with minimal morbidity and no activity restrictions. Adoption of this approach may keep a large number of patients with pilonidal disease from undergoing unindicated resection.", "provenance": [ { "field": "n", "quote": "One hundred two patients presented" }, { "field": "population", "quote": "consecutive new patients presenting to an outpatient pilonidal care clinic with mild disease" }, { "field": "intervention", "quote": "improved hygiene to limit debris in the gluteal crease, excision of midline pilonidal pits under local anesthesia to prevent intrusion of debris with drainage of any nidus present, and laser ablation of midline follicles to prevent new pits from forming" }, { "field": "comparator", "quote": "nidus resection is often recommended, even for patients with mild pilonidal disease, despite significant postoperative morbidity" }, { "field": "primaryOutcome", "quote": "77 of the 78 who continued care had resolution of their pilonidal disease" }, { "field": "result", "quote": "77 of the 78 who continued care had resolution of their pilonidal disease after a mean of 3 ± 2.5 laser epilations and 1.3 ± 1 pit excisions during 4 ± 2 clinic visits over a treatment duration of 30 ± 19 weeks" } ] }, { "id": "pmid:35989794", "pmid": "35989794", "doi": "10.7759/cureus.26948", "nctId": null, "pmcid": "PMC9378937", "title": "Evaluation of the Early Outcomes of Laser-Endoscopic Pilonidal Sinus Treatment Combination and Comparison With the Combination of Cautery-Phenol-Endoscopic Pilonidal Sinus Treatment", "firstAuthor": "Dönmez", "multipleAuthors": true, "journal": "Cureus", "year": 2022, "design": "retrospective", "n": 42, "nField": "reported", "population": "patients over 16 with pilonidal sinus disease, primary or recurrent, without active infection", "intervention": "laser combined with endoscopic pilonidal sinus treatment", "comparator": "cautery-phenol combined with endoscopic pilonidal sinus treatment", "primaryOutcome": "time to return to daily life, pain-free walking, recovery time, and recurrence", "result": "No significant difference in return to daily life, pain-free walking, recovery time, or recurrence, but shorter operation time and less pain on day of surgery with laser combination", "resultDirection": "mixed", "quality": "low", "qualityWhy": "Small retrospective study comparing two groups with short follow-up, so results may not be reliable or lasting.", "directness": "direct", "limitations": "Retrospective design, small sample size, and short follow-up period; authors state larger studies with longer follow-up are needed.", "followUp": "", "plainFinding": "Faster surgery, less pain, similar healing.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35989794/", "sourceText": "Introduction Although there are several methods used in the treatment of pilonidal sinus, research is still ongoing for the most effective method. Minimally invasive surgical methods, alone or in combination, are currently considered the closest treatment modalities to the ideal. The purpose of this study was to evaluate the early outcomes of laser-endoscopic pilonidal sinus treatment combination and compare it with the combination of phenol-cautery-endoscopic pilonidal sinus treatment. Materials and methods This is a retrospective study of 42 patients with pilonidal sinus disease treated between September 2020 and April 2022. A total of 26 participants in group one were treated with the laser-endoscopic pilonidal sinus treatment combination, and the remaining 16 in group two were treated with the cautery-phenol-endoscopic pilonidal sinus treatment combination. Both primary and recurrent patients over 16 years of age without active infection were included. In the postoperative period, each patient was followed up at the outpatient clinic. Perioperative and follow-up data were recorded. Results Patients were predominantly male. There was no significant difference between the two groups with regards to the time to return to daily life, pain-free walking, recovery time, and recurrence. However, in group one, the operation time was statistically shorter (p = 0.02), and the rate of sitting on the toilet without pain on the day of surgery was significantly higher (p = 0.029). In addition, none of the patients in this group needed painkillers and all returned to work earlier. Conclusion The combination of laser-endoscopic pilonidal sinus treatment is a feasible procedure with a 92.3% complete recovery rate according to the early results. However, studies with a larger sample size and longer follow-up period are required to confirm the validity of our results.", "provenance": [ { "field": "n", "quote": "retrospective study of 42 patients with pilonidal sinus disease" }, { "field": "population", "quote": "Both primary and recurrent patients over 16 years of age without active infection were included." }, { "field": "intervention", "quote": "26 participants in group one were treated with the laser-endoscopic pilonidal sinus treatment combination" }, { "field": "comparator", "quote": "the remaining 16 in group two were treated with the cautery-phenol-endoscopic pilonidal sinus treatment combination" }, { "field": "primaryOutcome", "quote": "There was no significant difference between the two groups with regards to the time to return to daily life, pain-free walking, recovery time, and recurrence." }, { "field": "result", "quote": "However, in group one, the operation time was statistically shorter (p = 0.02), and the rate of sitting on the toilet without pain on the day of surgery was significantly higher (p = 0.029)." } ] }, { "id": "pmid:35985713", "pmid": "35985713", "doi": "10.1016/j.yapd.2022.03.001", "nctId": null, "pmcid": null, "title": "Updates on the Management of Pilonidal Disease", "firstAuthor": "Collings", "multipleAuthors": true, "journal": "Adv Pediatr", "year": 2022, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "children and teens with pilonidal cysts", "intervention": "laser hair removal and minimally invasive treatments", "comparator": "other surgical options", "primaryOutcome": "management of pilonidal disease", "result": "not clearly reported", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a general narrative review that only mentions laser epilation as one option without reporting specific results or data.", "directness": "indirect", "limitations": "No specific data, outcomes, or comparative results are given for laser treatment; it's a broad overview article.", "followUp": "", "plainFinding": "No specific results reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35985713/", "sourceText": "This article reviews the current practices and evidence on the management of pilonidal disease in the pediatric population. Medical management, use of laser epilation, and minimally invasive surgical options are highlighted with a brief review of more invasive surgical options for refractory disease.", "provenance": [ { "field": "population", "quote": "management of pilonidal disease in the pediatric population" }, { "field": "intervention", "quote": "use of laser epilation" }, { "field": "comparator", "quote": "minimally invasive surgical options are highlighted with a brief review of more invasive surgical options for refractory disease" }, { "field": "primaryOutcome", "quote": "This article reviews the current practices and evidence on the management of pilonidal disease" }, { "field": "result", "quote": "Medical management, use of laser epilation, and minimally invasive surgical options are highlighted" } ] }, { "id": "pmid:35842877", "pmid": "35842877", "doi": "10.1007/s00383-022-05175-2", "nctId": null, "pmcid": null, "title": "Burden of pilonidal disease and improvement in quality of life after treatment in adolescents", "firstAuthor": "Salimi-Jazi", "multipleAuthors": true, "journal": "Pediatr Surg Int", "year": 2022, "design": "case-series", "n": 101, "nField": "reported", "population": "Adolescents with pilonidal disease", "intervention": "Minimally invasive treatment with laser hair removal, sometimes combined with trephination", "comparator": "Same patients' condition before treatment (no separate control group)", "primaryOutcome": "Quality of life, including daily activities, sports, school/work attendance, and socializing", "result": "Quality of life significantly improved after treatment across all measured categories", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This study only compared patients before and after treatment with no control group, so it can't rule out other reasons for improvement.", "directness": "direct", "limitations": "No control group, 30 patients excluded for incomplete data, and before/after design without randomization", "followUp": "", "plainFinding": "Quality of life improved after laser treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35842877/", "sourceText": "PURPOSE: Pilonidal Disease (PD) affects adolescents in different aspects. We hypothesized that patients with different gender, ethnicity, and age have different quality of life (QOL) measurements which could improve with minimally invasive treatment (MIT). METHODS: 131 PD patients underwent MIT (laser epilation ± trephination) from 2019 to 2021. Patients' demographics were recorded. Before and after MIT, patients received QOL questionnaire consisting of four categories: daily activities, sports participation, school/work attendance, and socializing. Data were analyzed using Student and multivariate t test. P < 0.05 was considered statistically significant. RESULTS: 101 (51 male, 50 female) patients were included. 30 patients with incomplete data were excluded. 54% of patients were < 18 years old. 47.5% were Hispanic. Median symptom duration prior to presentation was 5.4 (1.3-15) months. Prior to MIT, patients' ability to perform daily activities, participate in sports, attend school/work, and socialize was moderately or severely impacted in 66%, 57%, 45%, and 23% of respondents, respectively; after MIT, only 7%, 8%, 2%, and 4% were affected (p < 0.01). Recurrence rate was 6%. Pre-MIT, older patients and non-Hispanics reported worse impact on their QOL. Symptom duration or PD recurrence did not correlate with patient's pre- or post-MIT QOL. CONCLUSION: Patients' ethnicity and age impacted QOL in PD. All patients' QOL significantly improved with MIT. Considering the importance of socializing, playing sports, and school/work attendance in adolescents, our study highlights importance of early treatment of PD.", "provenance": [ { "field": "n", "quote": "101 (51 male, 50 female) patients were included." }, { "field": "population", "quote": "Pilonidal Disease (PD) affects adolescents" }, { "field": "intervention", "quote": "131 PD patients underwent MIT (laser epilation ± trephination) from 2019 to 2021." }, { "field": "comparator", "quote": "Before and after MIT, patients received QOL questionnaire" }, { "field": "primaryOutcome", "quote": "QOL questionnaire consisting of four categories: daily activities, sports participation, school/work attendance, and socializing" }, { "field": "result", "quote": "after MIT, only 7%, 8%, 2%, and 4% were affected (p < 0.01)" } ] }, { "id": "pmid:35678224", "pmid": "35678224", "doi": "10.1111/ans.17838", "nctId": null, "pmcid": null, "title": "Minimally invasive treatment of pilonidal sinus disease in a paediatric population: comparison of two techniques", "firstAuthor": "Fernandes", "multipleAuthors": true, "journal": "ANZ J Surg", "year": 2022, "design": "retrospective", "n": 106, "nField": "reported", "population": "children and teens with pilonidal sinus disease", "intervention": "pit-picking plus laser ablation", "comparator": "sinusectomy (surgical removal of sinus tract)", "primaryOutcome": "healing time, recurrence, and complication rates", "result": "Laser ablation group had slower healing, more early healing failures, and more complications than sinusectomy, but similar recurrence rates", "resultDirection": "harm", "quality": "low", "qualityWhy": "This was a retrospective, non-randomized comparison, so differences could be due to factors other than the treatment itself.", "directness": "direct", "limitations": "Retrospective review without randomization, so treatment groups may not be fully comparable.", "followUp": "", "plainFinding": "Laser healed slower, more complications.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35678224/", "sourceText": "BACKGROUND: Pilonidal disease (PD) is a common and debilitating inflammatory condition with significant impact on quality of life. Minimally invasive techniques (MIT) have shown promising results comparing to traditional excision. Herein we present a comparison of two MIT techniques -sinusectomy (SE) and pit-picking plus laser ablation (PPL). METHODS: All cases of paediatric PD treated by PPL and SE at our center between August 2018 and August 2020 were retrospectively reviewed. RESULTS: One-hundred and six patients were included, with a median age of 16 years (IQR 15-16). PPL was the procedure of choice in 36 patients (34%) and the remaining underwent SE (66%). Median healing time was significantly lower in SE group (20 days), comparing to PPL (30 days) (p = 0.002). Early healing failure occurred more frequently in the PPL group (p = 0.003). Recurrence rate was similar between groups - PPL 17% versus SE 16% (p = 0.89). Overall complication rate was 9% and was significantly higher in PPL (p = 0.03). CONCLUSIONS: MIT techniques are promising solutions in PD treatment. Although similarly easy and fast to perform, SE technique showed better healing profile and lower complication rate but no significant difference on recurrence rates was observed.", "provenance": [ { "field": "population", "quote": "All cases of paediatric PD treated by PPL and SE at our center between August 2018 and August 2020 were retrospectively reviewed." }, { "field": "intervention", "quote": "pit-picking plus laser ablation (PPL)" }, { "field": "comparator", "quote": "sinusectomy (SE)" }, { "field": "primaryOutcome", "quote": "Median healing time was significantly lower in SE group (20 days), comparing to PPL (30 days) (p = 0.002)." }, { "field": "result", "quote": "Early healing failure occurred more frequently in the PPL group (p = 0.003). Recurrence rate was similar between groups - PPL 17% versus SE 16% (p = 0.89). Overall complication rate was 9% and was significantly higher in PPL (p = 0.03)." }, { "field": "n", "quote": "One-hundred and six patients were included" } ] }, { "id": "pmid:35446708", "pmid": "35446708", "doi": "10.1308/rcsann.2022.0005", "nctId": null, "pmcid": "PMC9889171", "title": "Pilonidal sinus laser-assisted closure (PiLAC) - a low-morbidity alternative to excision with excellent long-term outcomes", "firstAuthor": "Johnson", "multipleAuthors": true, "journal": "Ann R Coll Surg Engl", "year": 2023, "design": "case-series", "n": 35, "nField": "reported", "population": "adults with primary or recurrent pilonidal sinus disease having day-case surgery", "intervention": "laser-assisted closure of the pilonidal sinus (PiLAC)", "comparator": "none - single-arm study, no direct comparison group", "primaryOutcome": "whether the sinus healed completely or came back (recurrence) on long-term follow-up", "result": "25 of 28 patients followed long-term (89.3%) had healed with no recurrence", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small single-centre case series without a comparison group, so it can't prove laser treatment is better than surgery, only that most patients healed.", "directness": "direct", "limitations": "Small sample size, no control/comparator arm, mixed prospective/retrospective data collection, and variable follow-up duration.", "followUp": "mean 407 days (range 67-887 days)", "plainFinding": "Most healed, low recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35446708/", "sourceText": "INTRODUCTION: Recurrence after surgery for pilonidal sinus disease is a recognised problem and patients often re-present months after discharge. We routinely treat primary and recurrent pilonidal sinus disease with Pilonidal sinus Laser-Assisted Closure (PiLAC). Long-term outcomes following PiLAC surgery was examined following clinical and telephone review. METHODS: All patients undergoing PiLAC as a day-case between April 2016 and July 2019 were included. Patients were followed up in a nurse-led clinic until complete healing or recurrence. A prospective database and retrospective audit of notes combined with longer-term follow-up by telephone were used. RESULTS: A total of 35 patients underwent PiLAC, median age 28 (18-53 years), 28 males:7 females. A total of 28 patients had long-term (>60 days) follow-up, mean 407 days (range 67-887 days); 25/28 patients (89.3%) had healed with no recurrence on long-term follow-up. Of these 28 patients, 11 were first presentation of pilonidal disease and underwent PiLAC as their first treatment, with a 91% heal rate long term. A total of 15 patients had seton drainage prior to PiLAC, with a 93% heal rate versus no seton (83%). Fisher's exact test showed no significant difference between sex, new/recurrent pilonidal disease and seton placement (p>0.05). CONCLUSIONS: Healing after PiLAC for the treatment of primary and recurrent pilonidal sinus disease is preserved with excellent long-term outcomes. We recommend it as an alternative to surgical excision.", "provenance": [ { "field": "n", "quote": "A total of 35 patients underwent PiLAC" }, { "field": "population", "quote": "All patients undergoing PiLAC as a day-case between April 2016 and July 2019 were included." }, { "field": "intervention", "quote": "Pilonidal sinus Laser-Assisted Closure (PiLAC)" }, { "field": "comparator", "quote": "We recommend it as an alternative to surgical excision." }, { "field": "primaryOutcome", "quote": "Patients were followed up in a nurse-led clinic until complete healing or recurrence." }, { "field": "result", "quote": "25/28 patients (89.3%) had healed with no recurrence on long-term follow-up." }, { "field": "followUp", "quote": "mean 407 days (range 67-887 days)" } ] }, { "id": "pmid:35112061", "pmid": "35112061", "doi": "10.47717/turkjsurg.2021.5100", "nctId": null, "pmcid": "PMC8776418", "title": "Management of sacrococcygeal pilonidal sinus disease in children: A survey study in Turkey", "firstAuthor": "Gurbanov", "multipleAuthors": true, "journal": "Turk J Surg", "year": 2021, "design": "case-series", "n": 88, "nField": "reported", "population": "Turkish pediatric surgeons treating children with pilonidal sinus disease", "intervention": "Laser epilation recommended to patients", "comparator": "Surgical excision versus minimally invasive procedures", "primaryOutcome": "Surgeons' preferred management practices and opinions on pilonidal sinus disease", "result": "85.2% of surgeons recommended laser epilation to patients, but no patient outcomes or efficacy data were reported", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a survey of surgeons' opinions and practice patterns, not a study measuring actual patient outcomes from laser treatment.", "directness": "indirect", "limitations": "Low response rate (19%), survey of physician opinions rather than clinical outcomes, no randomization or comparison of actual treatment results.", "followUp": "", "plainFinding": "Survey of surgeon opinions, not outcomes.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35112061/", "sourceText": "OBJECTIVES: Sacrococcygeal pilonidal sinus disease is common in children. The disease reduces the quality of life of patients with symptoms such as pain and chronic discharge. Variable surgical techniques have been described for the treatment of pilonidal sinus disease. This study aims to evaluate clinical approach of Turkish pediatric surgeons to children with pilonidal sinus disease. MATERIAL AND METHODS: Survey questions were prepared through a literature review for controversial issues. The participants were asked pre-selected and checkbox questions. The survey was sent to 450 pediatric surgeons, members of the Association of Turkey Pediatric Surgery via a link to Google Forms. RESULTS: Nineteen percent (88) of the members responded. Seventy five (85.2%) of the pediatric surgeons stated that they did not perform additional preoperative imaging. Surgical excision methods were preferred more than minimally invasive procedures (102 to 46). Sixty (68.2%) of the participants preferred preoperative prophylactic single dose intravenous antibiotics and postoperative oral antibiotics. Regarding the participants' practices, poor local hygiene, overweight, wide or deep sinus pit were stated as the most common causes of recurrence. Vast majority of the pediatric surgeons recommended laser epilation (%85.2) and slimming (59.1%) to patients. CONCLUSION: Various studies have been published from Turkey for pilonidal sinus disease. As seen in the current study, Turkish pediatric surgeons do not have a common opinion in pilonidal sinus disease and prefer surgical excision methods more frequently. Prospective randomized studies with bigger number of patients are required to establish common guidelines in disease management.", "provenance": [ { "field": "n", "quote": "Nineteen percent (88) of the members responded." }, { "field": "population", "quote": "This study aims to evaluate clinical approach of Turkish pediatric surgeons to children with pilonidal sinus disease." }, { "field": "intervention", "quote": "Vast majority of the pediatric surgeons recommended laser epilation (%85.2) and slimming (59.1%) to patients." }, { "field": "comparator", "quote": "Surgical excision methods were preferred more than minimally invasive procedures (102 to 46)." }, { "field": "primaryOutcome", "quote": "The participants were asked pre-selected and checkbox questions." }, { "field": "result", "quote": "Vast majority of the pediatric surgeons recommended laser epilation (%85.2) and slimming (59.1%) to patients." } ] }, { "id": "pmid:35025023", "pmid": "35025023", "doi": "10.1007/s10151-021-02568-8", "nctId": null, "pmcid": null, "title": "Endoscopic pilonidal sinus treatment vs. laser-assisted endoscopic pilonidal sinus treatment: short-term results from a retrospective case-matched study", "firstAuthor": "Gulcu", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2022, "design": "retrospective", "n": 96, "nField": "reported", "population": "patients who underwent LEPSIT and EPSIT procedures for PSD", "intervention": "laser-assisted EPSIT (LEPSIT)", "comparator": "endoscopic pilonidal sinus treatment (EPSIT)", "primaryOutcome": "The primary endpoint was complete wound healing", "result": "Wound healing rates (LEPSIT; 95.8% vs. EPSIT; 93%; p = 0.99) were similar in both groups.", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a small retrospective case-matched study with short follow-up, so it can't prove laser treatment truly works better.", "directness": "direct", "limitations": "Retrospective design, small laser group (n=24), short follow-up (3-15 months), no randomization.", "followUp": "9 months", "plainFinding": "Similar healing, less pain with laser.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35025023/", "sourceText": "BACKGROUND: The aim of this study was to investigate whether the addition of laser to the endoscopic pilonidal sinus treatment (EPSIT), laser-assisted EPSIT (LEPSIT) has an effect on the method and clinical results in the treatment of pilonidal sinus disease (PSD). METHODS: Between September 2019 and September 2020, patients who underwent LEPSIT and EPSIT procedures for PSD at Bursa Medicana Hospital, Turkey, were matched for age, pit location and number, body mass index (BMI), and sex. The primary endpoint was complete wound healing and the secondary endpoints were quality of life, cosmetic results, and cost. RESULTS: Twenty-four LEPSIT patients were matched to 72 EPSIT patients. Eighty-one (84.4%) of the included patients were male, and the median age was 26 years (range 16-52 years). The median follow-up time was 9 months (range 3-15 months).Wound healing rates (LEPSIT; 95.8% vs. EPSIT; 93%; p = 0.99) were similar in both groups. In patients who underwent LEPSIT, the operative time (p = 0.00086) was significantly shorter, time taken to return to work (p = 0.03572) and wound closure (p < 0.00001) were significantly less. However, the time taken to return to daily activities and the percentage of wound complications were similar in both groups. The pain scores on postoperative -days 1 7, and 14 were significantly higher after EPSIT (p = 0.0083, p = 0.00054, and p = 0.0479, respectively). The postoperative analgesic requirement was significantly higher after EPSIT (p = 0.01492). The total hospital cost was significantly less in patients who underwent EPSIT (p < 0.00001). Significantly better cosmetic improvement was observed in LEPSIT procedure (p = 0.00694). First month quality of life (evaluated with the Short Form 36 Health Survey Questionnaire) was similar except for bodily pain (better after LEPSIT). CONCLUSIONS: The success rates of LEPSIT and EPSIT are similar. LEPSIT results in better wound healing and patient comfort, and a shorter time to return to work.", "provenance": [ { "field": "n", "quote": "Twenty-four LEPSIT patients were matched to 72 EPSIT patients." }, { "field": "population", "quote": "patients who underwent LEPSIT and EPSIT procedures for PSD" }, { "field": "intervention", "quote": "laser-assisted EPSIT (LEPSIT)" }, { "field": "comparator", "quote": "endoscopic pilonidal sinus treatment (EPSIT)" }, { "field": "primaryOutcome", "quote": "The primary endpoint was complete wound healing" }, { "field": "result", "quote": "Wound healing rates (LEPSIT; 95.8% vs. EPSIT; 93%; p = 0.99) were similar in both groups." }, { "field": "followUp", "quote": "The median follow-up time was 9 months (range 3-15 months)." } ] }, { "id": "pmid:34993686", "pmid": "34993686", "doi": "10.1007/s10151-021-02550-4", "nctId": null, "pmcid": null, "title": "Sinus laser-assisted closure (SiLaC®) for pilonidal disease: results of a multicentre cohort study", "firstAuthor": "Sluckin", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2022, "design": "prospective-cohort", "n": 311, "nField": "reported", "population": "patients with pilonidal disease", "intervention": "sinus laser-assisted closure (SiLaC®) treatment", "comparator": "no comparator; before/after single-arm outcomes across repeated treatments", "primaryOutcome": "recurrence of pilonidal disease after treatment", "result": "After one treatment 26% had recurrence and 7% had incomplete wound closure (66% initial success); success rose to 92% after two treatments and 98% after three treatments", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a single-arm, partly retrospective cohort without a comparison group, so it can show how the laser treatment performs but cannot prove it works better than other options.", "directness": "direct", "limitations": "Partial retrospective data collection and no control group for comparison; follow-up time varied widely between patients.", "followUp": "median follow-up of 10 months (range 1-52 months)", "plainFinding": "Often needed repeat laser treatments to work.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34993686/", "sourceText": "BACKGROUND: An emerging and promising minimally invasive treatment for pilonidal disease (PD) is sinus laser-assisted closure (SiLaC®). Previous studies have shown encouraging results concerning safety, patient satisfaction, wound healing and acceptable recurrence rates. This study investigated outcomes for a large cohort of PD patients treated with SiLaC®. METHODS: A multicentre cohort study with a prospective design and partial retrospective data collection for patients with PD treated with SiLaC® in three hospitals in the Netherlands (Albert Schweitzer Hospital, Flevoziekenhuis and Medical Centre Zuiderzee) from January 1st 2017 to March 1st 2020. The primary outcome was recurrence. Secondary outcomes were incidence of complete wound closure, time until wound closure, postoperative complications, ability to perform daily activities and reported patient satisfaction. RESULTS: A total of 311 patients were included with a median follow-up of 10 months (range 1-52 months). The recurrence rate after one SiLaC® treatment was 26% with 7% experiencing incomplete wound closure, resulting in an initial success rate of 66% after one SiLaC® procedure. This increased to 92% and 98% after two and three SiLaC® procedures, respectively. Mean time until wound closure was 6 weeks (range 1-24 weeks). Seven patients (2%) were still unsuccessfully treated after three SiLaC® treatments and required additional and extensive surgery. Mean time to perform regular daily activities including working was 6 days (range 0-42 days) and the vast majority of patients (84%) did not require painkillers or only paracetamol. Twelve patients (4%) developed a postoperative wound infection. The mean satisfaction score was 9 (range 5-10). CONCLUSIONS: SiLaC® is a promising minimally invasive treatment for PD with high patient satisfaction and an acceptable success rate. These results suggest that SiLaC® could be used as a safe and effective primary treatment for PD.", "provenance": [ { "field": "population", "quote": "patients with PD treated with SiLaC®" }, { "field": "intervention", "quote": "sinus laser-assisted closure (SiLaC®)" }, { "field": "comparator", "quote": "A multicentre cohort study with a prospective design and partial retrospective data collection" }, { "field": "primaryOutcome", "quote": "The primary outcome was recurrence." }, { "field": "result", "quote": "The recurrence rate after one SiLaC® treatment was 26% with 7% experiencing incomplete wound closure, resulting in an initial success rate of 66% after one SiLaC® procedure. This increased to 92% and 98% after two and three SiLaC® procedures, respectively." }, { "field": "n", "quote": "A total of 311 patients were included with a median follow-up of 10 months (range 1-52 months)." }, { "field": "followUp", "quote": "median follow-up of 10 months (range 1-52 months)" } ] }, { "id": "pmid:34855026", "pmid": "34855026", "doi": "10.1007/s10151-021-02552-2", "nctId": null, "pmcid": null, "title": "Extensive suppuration and being overweight are factors associated with the failure of laser treatment for pilonidal disease: lessons from the first French retrospective cohort", "firstAuthor": "Spindler", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2022, "design": "retrospective", "n": 29, "nField": "reported", "population": "adults with pilonidal disease", "intervention": "laser treatment of the pilonidal sinus (SiLaT)", "comparator": "no comparison group reported", "primaryOutcome": "closure of skin openings with no ongoing discharge or abscess", "result": "About 69% of patients were cured, with 2 early failures and 7 recurrences", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a small, single-group study without a comparison treatment, so it can't show laser is better than other options.", "directness": "direct", "limitations": "Single-center retrospective design with no control group and only 29 patients.", "followUp": "370.3 days", "plainFinding": "Cured about 7 in 10 patients.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34855026/", "sourceText": "BACKGROUND: The aim of our study was to assess the efficacy of sinus laser therapy (SiLaT) for the treatment of pilonidal disease. METHODS: All adult patients treated with SiLaT in our department between June 1, 2018, and August 23, 2019, were included in the study. Success was defined as the closure of cutaneous orifices and the absence of discharge or abscesses. RESULTS: We included 29 consecutive patients (22 males) with a median age of 32.5 ± 10.5 years. Eight patients had already undergone prior surgery for pilonidal disease. The procedure was performed under spinal (55%) or general (45%) anesthesia. The mean follow-up was 370.3 days (± 165.8 days). We observed 2 primary failures (6.9%) and 7 recurrences (24.1%). Ultimately, 20 patients were considered to have been cured (69%). The mean time to healing was 25 days (± 8.1 days). No serious complications were reported. Usual activities were resumed within a mean of 4.9 days (± 7.2), and 86% of patients reported being \"very satisfied\" with the treatment. The body mass index was lower for patients who were cured (24.0 ± 3.6) than for those who experienced treatment failure (27.6 ± 3.4; p = 0.018). The cured patients were less likely to have one or more secondary openings (35.0 versus 88.9%, p = 0.014). CONCLUSIONS: Almost 70% of our patients were cured by SiLaT. Complications were rare and mild. The technique appeared to be less effective for overweight patients and those with one or more secondary openings associated with pilonidal pits.", "provenance": [ { "field": "n", "quote": "We included 29 consecutive patients (22 males)" }, { "field": "population", "quote": "All adult patients treated with SiLaT in our department" }, { "field": "intervention", "quote": "sinus laser therapy (SiLaT) for the treatment of pilonidal disease" }, { "field": "comparator", "quote": "All adult patients treated with SiLaT in our department between June 1, 2018, and August 23, 2019, were included in the study." }, { "field": "primaryOutcome", "quote": "Success was defined as the closure of cutaneous orifices and the absence of discharge or abscesses." }, { "field": "result", "quote": "We observed 2 primary failures (6.9%) and 7 recurrences (24.1%). Ultimately, 20 patients were considered to have been cured (69%)." }, { "field": "followUp", "quote": "The mean follow-up was 370.3 days (± 165.8 days)." } ] }, { "id": "pmid:34291332", "pmid": "34291332", "doi": "10.1007/s10103-021-03379-x", "nctId": null, "pmcid": null, "title": "Laser treatment of pilonidal disease: a systematic review", "firstAuthor": "Romic", "multipleAuthors": true, "journal": "Lasers Med Sci", "year": 2022, "design": "systematic-review", "n": 971, "nField": "reported", "population": "patients with chronic pilonidal disease", "intervention": "radially emitting laser treatment", "comparator": "none (no comparator group across pooled studies)", "primaryOutcome": "primary healing and recurrence rate after laser treatment", "result": "94.4% achieved primary healing with a 3.8% weighted mean recurrence rate and 10% minor complication rate", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This pooled uncontrolled case series data from only 10 studies without a comparison group or randomization, so it cannot show laser is better than other treatments.", "directness": "direct", "limitations": "No randomized controlled trials included, high heterogeneity in complication rates, results limited to mild chronic disease, lack of standardized severity classification and outcome reporting.", "followUp": "12 (range 7-25) months", "plainFinding": "High healing, low recurrence with laser.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34291332/", "sourceText": "Pilonidal disease (PD) is a common condition, and there is still an ongoing debate on ideal management that should be minimally invasive, safe, and efficient. The use of radially emitting laser in the treatment of chronic PD is a novel minimally invasive technique, and initial studies with a small number of patients showed promising results. This study aimed to assess the efficacy and safety of chronic PD treatment with a laser using a systematic review of the published literature. A systematic review was conducted after PubMed, Scopus, Embase, Web of Science, and the Cochrane database search for studies reporting laser treatment of chronic PD. Also, our unpublished prospective single-center study was included in this review. Ten of 87 studies were eligible for the review, including 971 patients. The median age of the patients was 26 (range 13-68), and the median operative time was 26 (range 6-65) min. With a median follow-up of 12 (range 7-25) months, 917 (94.4%) patients achieved primary healing with a weighted mean recurrence rate of 3.8%. The weighted mean complication rate was 10% (95% CI 5.7-14.3%, I2 = 82.28, p < 0.001), and all were minor. The published literature demonstrates that laser treatment is a promising procedure in the management of chronic PD. Furthermore, the review showed that standardized operative techniques and perioperative steps were used. The results were limited to the mild chronic PD. Classification of PD severity and standardized outcome reporting is required to define indications and contraindications for laser PD treatment. Randomized controlled trials are needed to determine the long-term effectiveness and superiority of laser treatment over other methods.", "provenance": [ { "field": "population", "quote": "studies reporting laser treatment of chronic PD" }, { "field": "intervention", "quote": "The use of radially emitting laser in the treatment of chronic PD" }, { "field": "comparator", "quote": "A systematic review was conducted after PubMed, Scopus, Embase, Web of Science, and the Cochrane database search for studies reporting laser treatment of chronic PD." }, { "field": "primaryOutcome", "quote": "917 (94.4%) patients achieved primary healing with a weighted mean recurrence rate of 3.8%" }, { "field": "result", "quote": "917 (94.4%) patients achieved primary healing with a weighted mean recurrence rate of 3.8%. The weighted mean complication rate was 10% (95% CI 5.7-14.3%, I2 = 82.28, p < 0.001), and all were minor." }, { "field": "n", "quote": "Ten of 87 studies were eligible for the review, including 971 patients." }, { "field": "followUp", "quote": "With a median follow-up of 12 (range 7-25) months" } ] }, { "id": "pmid:34124979", "pmid": "34124979", "doi": "10.1080/17434440.2021.1943362", "nctId": null, "pmcid": null, "title": "US Guided Si.La.D. A new technique for minimally invasive pilonidal disease treatment, using ultrasound guided laser ablation", "firstAuthor": "Papagiannopoulos", "multipleAuthors": true, "journal": "Expert Rev Med Devices", "year": 2021, "design": "case-series", "n": 17, "nField": "reported", "population": "people with pilonidal sinus disease", "intervention": "ultrasound-guided laser destruction of the pilonidal sinus tract (US guided Si.La.D.)", "comparator": "none reported", "primaryOutcome": "safety and complications of the procedure", "result": "no significant complications were recorded", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a small uncontrolled case series of only 17 patients with no comparison group, so it cannot show whether laser works better than other treatments.", "directness": "direct", "limitations": "No control group, small sample size, no long-term outcome or recurrence data reported.", "followUp": "", "plainFinding": "Safe with no major complications.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34124979/", "sourceText": "Background: The destruction of the pilonidal sinus with a radial laser probe has been suggested as a safe procedure with good results and low morbidity. Nevertheless, the drawbacks of this technique are: a blind technique, if the sinus has some ramifications or a non-linear development, we cannot be sure for their destruction.Methods: 17 patients (12 men, 5 women) were operated with US guided laser destruction - US guided Si.La.D. Laser destruction of the pathological tissue (cavity, sinus) was performed using a 400 μ radial optical fiber, connected and locked to a radiopaque biopsy needle 14 G, using a 12 MHz linear probe, to introduce and real-time echo guide the fiber in order to achieve laser ablation with 120-140 J /cm of pathological tissueResults: No significant complications were recorded.Conclusion: Real-time echo guided laser ablation of pilonidal sinus and cavities proved to be safe and efficient, providing controlled emission of laser energy only to the pathological tissue, increasing the accuracy of identify the right track to deliver energy, decreasing the risk of traumatic progression of surgical instrument into healthy subcutaneous tissue, accidental progression of the disease and missing in the same time tracts that need to be ablate.", "provenance": [ { "field": "n", "quote": "17 patients (12 men, 5 women) were operated with US guided laser destruction" }, { "field": "population", "quote": "17 patients (12 men, 5 women) were operated with US guided laser destruction - US guided Si.La.D." }, { "field": "intervention", "quote": "Laser destruction of the pathological tissue (cavity, sinus) was performed using a 400 μ radial optical fiber, connected and locked to a radiopaque biopsy needle 14 G, using a 12 MHz linear probe, to introduce and real-time echo guide the fiber in order to achieve laser ablation" }, { "field": "comparator", "quote": "Methods: 17 patients (12 men, 5 women) were operated with US guided laser destruction - US guided Si.La.D." }, { "field": "primaryOutcome", "quote": "No significant complications were recorded." }, { "field": "result", "quote": "No significant complications were recorded." } ] }, { "id": "pmid:34042233", "pmid": "34042233", "doi": "10.1111/codi.15755", "nctId": null, "pmcid": null, "title": "Sinus laser therapy versus sinus lay open in the management of sacrococcygeal pilonidal disease", "firstAuthor": "Abdelnaby", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2021, "design": "retrospective", "n": 139, "nField": "reported", "population": "patients with sacrococcygeal pilonidal disease", "intervention": "sinus laser therapy (SiLaT)", "comparator": "sinus lay open surgery", "primaryOutcome": "complete healing at 12 months, time to healing, complications, operation time, and quality of life", "result": "Lay open had fewer recurrences and was faster to perform, but laser therapy healed quicker, had better cosmetic results and higher quality of life scores; complication rates were similar", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective, non-randomized comparison, so differences between groups could be due to factors other than the treatment itself.", "directness": "direct", "limitations": "Retrospective design, not randomized, so selection bias may affect comparisons between groups.", "followUp": "12 months", "plainFinding": "More recurrence but faster healing with laser.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34042233/", "sourceText": "AIM: There is no standard method for the management of sacrococcygeal pilonidal disease (SPND); however, surgery remains the gold standard treatment. Wide surgical excision of the sinus is the traditional surgical treatment of SPND, yet it is associated with extended healing time and delayed recovery. This study aimed to compare the outcomes of sinus laser therapy (SiLaT) and sinus lay open in the management of SPND. METHODS: Patients with SPND who were treated with SiLaT or lay open were retrospectively reviewed. The main outcome measures were the success of surgery in terms of complete healing at 12 months postoperatively, time to complete healing, complications, operation time and quality of life (QoL). RESULTS: A total of 139 patients with a mean age of 25 years were included to the study. Sixty-two patients underwent SiLaT and 77 underwent lay open. Six patients experienced recurrence after SiLaT while there was no recorded recurrence after the lay open technique (P = 0.007). Sinus lay open had a shorter operation time than SiLaT (P < 0.0001). On the other hand, SiLaT was followed by a shorter healing time, lower incidence of delayed wound healing, better cosmetic outcome, and higher QoL scores compared to the lay open group. The complication rates were comparable between the two groups. CONCLUSION: Sinus lay open was associated with better success than SiLaT. On the other hand, SiLaT was associated with quicker healing, better cosmesis, better QoL and longer operation time. The complication rate of the two procedures was comparable.", "provenance": [ { "field": "n", "quote": "A total of 139 patients with a mean age of 25 years were included to the study." }, { "field": "population", "quote": "Patients with SPND who were treated with SiLaT or lay open were retrospectively reviewed." }, { "field": "intervention", "quote": "sinus laser therapy (SiLaT)" }, { "field": "comparator", "quote": "sinus lay open" }, { "field": "primaryOutcome", "quote": "The main outcome measures were the success of surgery in terms of complete healing at 12 months postoperatively, time to complete healing, complications, operation time and quality of life (QoL)." }, { "field": "result", "quote": "Six patients experienced recurrence after SiLaT while there was no recorded recurrence after the lay open technique (P = 0.007). Sinus lay open had a shorter operation time than SiLaT (P < 0.0001). On the other hand, SiLaT was followed by a shorter healing time, lower incidence of delayed wound healing, better cosmetic outcome, and higher QoL scores compared to the lay open group. The complication rates were comparable between the two groups." } ] }, { "id": "pmid:34021885", "pmid": "34021885", "doi": "10.1007/s13304-021-01094-4", "nctId": null, "pmcid": "PMC8606398", "title": "Pediatric endoscopic pilonidal sinus treatment (PEPSiT): what we learned after a 3-year experience in the pediatric population", "firstAuthor": "Esposito", "multipleAuthors": true, "journal": "Updates Surg", "year": 2021, "design": "retrospective", "n": 152, "nField": "reported", "population": "children and teenagers with pilonidal sinus disease", "intervention": "endoscopic pilonidal sinus surgery combined with laser therapy before and after surgery", "comparator": "", "primaryOutcome": "complete healing within 8 weeks, healing time, complications and recurrence", "result": "95.4% of patients healed completely within 8 weeks, with a 4.6% recurrence rate and low complication rates", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a retrospective case series with no comparison group, so it cannot show whether the laser itself made any difference.", "directness": "indirect", "limitations": "Retrospective design, no control group, and laser therapy was combined with endoscopic surgery rather than tested alone.", "followUp": "12.8 months", "plainFinding": "High healing, low recurrence with combined surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34021885/", "sourceText": "This paper aimed to report a multi-institutional 3-year experience with pediatric endoscopic pilonidal sinus treatment (PEPSiT) and describe tips and tricks of the technique. We retrospectively reviewed all patients < 18 years, with primary or recurrent pilonidal sinus disease (PSD), undergoing PEPSiT in the period 2017-2020. All patients received pre-operative laser therapy, PEPSiT and post-operative dressing and laser therapy. Success rate, healing rate/time, post-operative management, short- and long-term outcome and patient satisfaction were assessed. A total of 152 patients (98 boys) were included. Median patient's age was 17.1 years. Fifteen/152 patients (9.8%) presented a recurrent PSD. All patients resumed full daily activities 1 day after surgery. The post-operative course was painless in 100% of patients (median VAS pain score < 2/10). Patient satisfaction was excellent (median score 4.8). The median follow-up was 12.8 months (range 1-36). Complete healing in 8 weeks was achieved in 145/152 (95.4%) and the median healing time was 24.6 days (range 16-31). We reported post-operatively immediate Clavien grade 2 complications (3 oedema, 2 burns) in 5/152 (3.3%) and delayed Clavien grade 2 complications (3 granulomas, 8 wound infections) in 11/152 (7.2%). Disease recurrence occurred in 7/152 (4.6%), who were re-operated using PEPSiT. PEPSiT should be considered the standard of care for surgical treatment of PSD in children and teenagers. PEPSiT is technically easy, with short and painless post-operative course and low recurrence rate (4.6%). Standardized treatment protocol, correct patient enrollment and information, and intensive follow-up are key points for the success of the procedure.", "provenance": [ { "field": "n", "quote": "A total of 152 patients (98 boys) were included." }, { "field": "population", "quote": "All patients < 18 years, with primary or recurrent pilonidal sinus disease (PSD), undergoing PEPSiT" }, { "field": "intervention", "quote": "All patients received pre-operative laser therapy, PEPSiT and post-operative dressing and laser therapy." }, { "field": "primaryOutcome", "quote": "Success rate, healing rate/time, post-operative management, short- and long-term outcome and patient satisfaction were assessed." }, { "field": "result", "quote": "Complete healing in 8 weeks was achieved in 145/152 (95.4%) and the median healing time was 24.6 days (range 16-31)." }, { "field": "result", "quote": "Disease recurrence occurred in 7/152 (4.6%), who were re-operated using PEPSiT." }, { "field": "followUp", "quote": "The median follow-up was 12.8 months (range 1-36)." } ] }, { "id": "pmid:33988547", "pmid": "33988547", "doi": "10.1097/DSS.0000000000003080", "nctId": null, "pmcid": null, "title": "A Retrospective Study of the Safety and Efficacy of a Radial Diode Laser Probe in the Management of Pilonidal Sinus Disease", "firstAuthor": "Bonito", "multipleAuthors": true, "journal": "Dermatol Surg", "year": 2021, "design": "retrospective", "n": 25, "nField": "reported", "population": "patients with pilonidal sinus disease", "intervention": "radial 1,470-nm diode laser treatment of the sinus", "comparator": "none (no comparison group)", "primaryOutcome": "treatment success and recurrence of pilonidal sinus", "result": "84% success rate with 9.5% recurrence after a mean follow-up of 8.3 months", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small retrospective study without a comparison group, so it cannot show whether the laser works better than other treatments.", "directness": "direct", "limitations": "Retrospective design, no control group, small sample size, and short follow-up.", "followUp": "8.3 months", "plainFinding": "High success, low recurrence with laser.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33988547/", "sourceText": "BACKGROUND: Recently, the interest in minimally invasive techniques in the management of the pilonidal sinus has been rising. The main goal is to avoid the prolonged recovery period associated with traditional surgeries. OBJECTIVE: To evaluate the safety and efficacy of a radial diode laser probe in the destruction of the pilonidal sinus. METHODS: Twenty-seven patients with pilonidal sinus were treated with a radial 1,470-nm diode laser between July 2018 and August 2020 and were examined retrospectively. Charts were reviewed and patients were questioned by telephone about their postlaser recovery period. RESULTS: Twenty-five patients were included. The overall success rate was 84%. Recurrence rate was 9.5%, after a mean follow-up of 8.3 months. The mean duration of analgesia intake was 2.5 days, and the mean period required to return to daily activities was 5.8 days. Sixteen percent of the patients developed a small postoperative hemorrhage as a complication. CONCLUSION: This study demonstrated that radial diode laser is safe, effective, and associated with a low recurrence rate in the treatment of mild pilonidal sinus disease. Dermatologists can perform it easily in the outpatient clinic, with minimal postoperative pain and a fast return to the patients' daily activities.", "provenance": [ { "field": "n", "quote": "Twenty-five patients were included." }, { "field": "population", "quote": "Twenty-seven patients with pilonidal sinus" }, { "field": "intervention", "quote": "treated with a radial 1,470-nm diode laser" }, { "field": "comparator", "quote": "evaluate the safety and efficacy of a radial diode laser probe in the destruction of the pilonidal sinus" }, { "field": "primaryOutcome", "quote": "The overall success rate was 84%. Recurrence rate was 9.5%" }, { "field": "result", "quote": "The overall success rate was 84%. Recurrence rate was 9.5%, after a mean follow-up of 8.3 months." } ] }, { "id": "pmid:33966964", "pmid": "33966964", "doi": "10.1016/j.asjsur.2021.04.026", "nctId": null, "pmcid": null, "title": "Sinus laser closure (SiLaC) versus Limberg flap in management of pilonidal disease: A short-term non-randomized comparative prospective study", "firstAuthor": "Algazar", "multipleAuthors": true, "journal": "Asian J Surg", "year": 2022, "design": "prospective-cohort", "n": 71, "nField": "reported", "population": "patients with pilonidal disease", "intervention": "sinus laser closure (SiLaC)", "comparator": "Limberg flap surgery", "primaryOutcome": "healing rate and recurrence", "result": "SiLaC achieved 95.8% primary healing with similar recurrence to Limberg flap, but shorter operative time, hospital stay, and less pain", "resultDirection": "mixed", "quality": "low", "qualityWhy": "Small, non-randomized study with short follow-up, so results may not hold up over time or in other patients.", "directness": "direct", "limitations": "Non-randomized, short-term follow-up, small sample size", "followUp": "short-term", "plainFinding": "Comparable healing, quicker recovery with laser", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33966964/", "sourceText": "INTRODUCTION: Fistula Laser Closure (FiLAC) is a method that was originally applied in the treatment of perianal fistulas. Because of promising results, diode lasers were later on used to treat pilonidal sinus disease in a method called sinus Laser Closure (SiLaC). The aim of this study is to compare between SiLaC and Limberg flap in management of pilonidal disease. METHODS: A prospective, nonrandomized comparative study. A short-term follow-up of 71 patients with pilonidal disease was analyzed (24 operated on using the SiLaC technique and 47 using the Limberg technique). With a primary outcome is healing rate and recurrence and a secondary outcome is other measures i.e. complications, hospital stay and postoperative pain. RESULTS: The median operative time in the SiLaC group was 26.45 ± 5.41 min (20-35 min) and in the Limberg group 58.63 ± 7.42 min (50-75 min). In the SiLaC group, the primary healing was achieved in 23 out of 24 patients (95.8%) with a total complication rate of 20.83%. There were two cases of recurrence after initial healing in each group. CONCLUSION: Sinus laser Closure (SiLaC) is comparable to Limberg flap technique in the terms of healing rate and recurrence with better outcome regarding operative time, hospital stay and post-operative pain.", "provenance": [ { "field": "n", "quote": "A short-term follow-up of 71 patients with pilonidal disease was analyzed" }, { "field": "population", "quote": "71 patients with pilonidal disease" }, { "field": "intervention", "quote": "24 operated on using the SiLaC technique" }, { "field": "comparator", "quote": "47 using the Limberg technique" }, { "field": "primaryOutcome", "quote": "primary outcome is healing rate and recurrence" }, { "field": "result", "quote": "Sinus laser Closure (SiLaC) is comparable to Limberg flap technique in the terms of healing rate and recurrence with better outcome regarding operative time, hospital stay and post-operative pain." } ] }, { "id": "pmid:33728570", "pmid": "33728570", "doi": "10.1007/s10151-021-02432-9", "nctId": null, "pmcid": "PMC8124060", "title": "A mapping review of sacrococcygeal pilonidal sinus disease", "firstAuthor": "Kumar", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2021, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus disease", "intervention": "laser depilation", "comparator": "not specified", "primaryOutcome": "not reported for laser treatment specifically", "result": "laser depilation was identified as a gap in research needing future randomised controlled trials, not as an evaluated treatment with outcomes", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a mapping review that counts and categorises existing studies rather than measuring whether laser treatment works, so it gives no outcome data to judge effectiveness.", "directness": "indirect", "limitations": "abstract states evidence base for pilonidal sinus management is 'poor quality, poorly focused and rapidly proliferating' and this review only maps study types rather than assessing treatment effects", "followUp": "", "plainFinding": "No outcome data on laser", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33728570/", "sourceText": "BACKGROUND: Pilonidal sinus is a hole in the natal cleft which may cause severe pain and become infected. The evidence base for management of pilonidal sinus is said to be poor quality, poorly focused and rapidly proliferating. We undertook a systematic mapping review to provide a broad overview of the field and support the identification of research priorities. METHODS: We searched MEDLINE, CINAHL, and EMBASE from inception to 22nd Nov 2020 for primary research studies focused on the management of pilonidal sinus. We extracted data on study design and categorised studies under five major headings ('non-surgical treatment', 'surgical treatment', 'aftercare' and 'other'), producing frequency counts for different study designs. Gaps in research were identified from published systematic reviews and tabulated. RESULTS: We identified 983 eligible studies, of which 36 were systematic reviews and/or meta-analyses; 121 were randomised controlled trials), and 826 observational studies of various design. The majority of studies evaluated surgical techniques (n = 665), or adjuvant medical interventions (n = 98). The literature on wound care has developed most recently, and the evidence base includes 30% randomised controlled trials. Gaps analysis highlighted comparison of surgical techniques including flaps, laser depilation, and wound care interventions as potential areas for randomised controlled trials. CONCLUSIONS: This mapping review summarises eight decades of research on the management of pilonidal sinus. Further research is needed to identify front-running interventions, understand variation in practice and patient values, and to prioritise future research.", "provenance": [ { "field": "population", "quote": "Pilonidal sinus is a hole in the natal cleft which may cause severe pain and become infected." }, { "field": "intervention", "quote": "comparison of surgical techniques including flaps, laser depilation, and wound care interventions as potential areas for randomised controlled trials" }, { "field": "result", "quote": "Gaps analysis highlighted comparison of surgical techniques including flaps, laser depilation, and wound care interventions as potential areas for randomised controlled trials." }, { "field": "primaryOutcome", "quote": "We extracted data on study design and categorised studies under five major headings" }, { "field": "comparator", "quote": "comparison of surgical techniques including flaps, laser depilation, and wound care interventions as potential areas for randomised controlled trials" } ] }, { "id": "pmid:32964496", "pmid": "32964496", "doi": "10.1002/lsm.23318", "nctId": null, "pmcid": null, "title": "Standardization of Pre- and Postoperative Management Using Laser Epilation and Oxygen-Enriched Oil-Based Gel Dressing in Pediatric Patients Undergoing Pediatric Endoscopic Pilonidal Sinus Treatment (PEPSiT)", "firstAuthor": "Esposito", "multipleAuthors": true, "journal": "Lasers Surg Med", "year": 2020, "design": "retrospective", "n": 87, "nField": "reported", "population": "pediatric patients aged 12-18 with chronic pilonidal sinus disease undergoing endoscopic surgical treatment", "intervention": "laser hair removal plus oxygen-enriched oil-based gel dressing before and after surgery", "comparator": "silver sulfadiazine spray dressing after surgery only", "primaryOutcome": "wound healing time, disease recurrence, and wound infection rate", "result": "laser plus gel dressing group healed faster and had lower recurrence and infection rates than the spray-dressing group", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this was a retrospective comparison of two historical treatment protocols, not a randomized trial, so differences between groups could be due to other factors.", "directness": "direct", "limitations": "retrospective design comparing two different time periods/protocols rather than a randomized comparison, small sample size, single center", "followUp": "", "plainFinding": "Faster healing, fewer recurrences with laser.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32964496/", "sourceText": "BACKGROUND AND OBJECTIVE: Pediatric endoscopic pilonidal sinus treatment (PEPSiT) has become the new standard of care for pilonidal sinus disease (PSD) in pediatric patients. This study aimed to compare our current wound treatment protocol (laser epilation (LE) and oxygen-enriched oil-based gel dressing) with our previous protocol (silver sulfadiazine spray) and demonstrate its efficacy as means to prevent PSD recurrence in children undergoing PEPSiT. STUDY DESIGN/MATERIALS AND METHODS: We retrospectively reviewed the data of 87 pediatric patients, 52 boys and 35 girls, with an average age of 17.1 years (range, 12-18) affected by chronic PSD, who underwent PEPSiT over a 24-month period (December 2017-December 2019). The patients were divided into two groups: G1 (n = 47) treated with pre- and postoperative LE and oxygen-enriched oil-based gel dressing; and G2 (n = 40) treated with only postoperative dressing using silver sulfadiazine spray. The two groups were compared regarding the operative outcome, wound-healing time, disease recurrence, wound infections, and other complications. Furthermore, efficacy, safety, and tolerability of LE were assessed in G1. RESULTS: No significant difference emerged between the two groups regarding the median operating time, postoperative pain score, hospital stay length, and time to full daily activities (P = 0.33). The median healing time significantly decreased in G1 (21 days) compared with G2 (28.1 days) (P = 0.001]. The disease recurrence rate was significantly lower in G1 (n = 1, 2.1%) compared with G2 (n = 6, 15%) (P = 0.001), and the wound infection rate was significantly lower in G1 (n = 1, 2.1%) compared with G2 (n = 4, 10%) (P = 0.001). All patients with wound infection were treated with oral antibiotics and, after the resolution of the acute episode, received LE with no further infections (Clavien II). Granuloma of the wound occurred in two G2 patients (5%), who were treated with topical silver nitrate (Clavien II). LE was well-tolerated and without complications in all G1 patients; a median number of 7 LE sessions (range, 4-10) at 4-6 weeks interval was required to achieve definitive hair removal. CONCLUSION: The results of this study confirmed that our standardized pre- and postoperative wound management, including LE and oxygen-enriched oil-based gel dressing, was extremely safe and effective in reducing PSD recurrence and wound infection rate in pediatric patients undergoing PEPSiT. LE should be routinely offered as adjunctive treatment to all patients who receive PEPSiT and is strongly advocated to be started before surgery and continued after wound healing. More importantly, LE showed to have a role as a preventive modality in patients with recurrent folliculitis or infections at the intergluteal crease. It was also associated with significant improvement and acceleration of wound-healing time. LE and oxygen-enriched oil-based gel dressings were clinically safe and well-tolerated in all patients, with no adverse skin reactions or injuries to both therapies. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.", "provenance": [ { "field": "population", "quote": "87 pediatric patients, 52 boys and 35 girls, with an average age of 17.1 years (range, 12-18) affected by chronic PSD, who underwent PEPSiT" }, { "field": "intervention", "quote": "G1 (n = 47) treated with pre- and postoperative LE and oxygen-enriched oil-based gel dressing" }, { "field": "comparator", "quote": "G2 (n = 40) treated with only postoperative dressing using silver sulfadiazine spray" }, { "field": "primaryOutcome", "quote": "compared regarding the operative outcome, wound-healing time, disease recurrence, wound infections, and other complications" }, { "field": "result", "quote": "The median healing time significantly decreased in G1 (21 days) compared with G2 (28.1 days) (P = 0.001]. The disease recurrence rate was significantly lower in G1 (n = 1, 2.1%) compared with G2 (n = 6, 15%) (P = 0.001), and the wound infection rate was significantly lower in G1 (n = 1, 2.1%) compared with G2 (n = 4, 10%) (P = 0.001)" }, { "field": "n", "quote": "We retrospectively reviewed the data of 87 pediatric patients" } ] }, { "id": "pmid:32862404", "pmid": "32862404", "doi": "10.1007/s10103-020-03137-5", "nctId": null, "pmcid": null, "title": "Effect of platelet-rich plasma on healing in laser pilonidoplasty for pilonidal sinus disease", "firstAuthor": "Kurt", "multipleAuthors": true, "journal": "Lasers Med Sci", "year": 2021, "design": "rct", "n": 50, "nField": "reported", "population": "patients treated for pilonidal sinus", "intervention": "laser pilonidoplasty plus platelet-rich plasma (PRP)", "comparator": "laser pilonidoplasty alone", "primaryOutcome": "duration of wound healing, hospital stay, time to return to work, complications", "result": "wound healing was faster with PRP added (4.1 weeks) vs laser alone (6.1 weeks); other outcomes similar", "resultDirection": "mixed", "quality": "low", "qualityWhy": "Small study of 50 patients comparing two laser-based treatments, not laser versus no laser or standard surgery, so it doesn't directly test whether laser itself works.", "directness": "indirect", "limitations": "Small sample size; compares two variants of laser treatment rather than laser versus a non-laser standard treatment or no treatment; abstract does not mention blinding or randomization method.", "followUp": "", "plainFinding": "Adding PRP sped up wound healing.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32862404/", "sourceText": "The aim of this study was to evaluate the effects of application of platelet-rich plasma in addition to laser pilonidoplasty for the treatment of pilonidal sinus. Twenty-five patients who were treated by laser pilonidoplasty for pilonidal sinus (group 1) and 25 patients who were treated by platelet-rich plasma in addition to laser pilonidoplasty (group 2) at this clinic were included in the study. Patients were classified according to the Irkorucu and Adana Numune's classification and treatment concept. Duration of stay of the patients in the hospital, time to start daily activities, duration of wound healing, recurrence, and complications were evaluated. Among the 50 patients included in the study, 41 (%82) were males and 9 (%18) were females. The mean age was 25.6 ± 2.4 years and 24.8 ± 3.8 years in groups 1 and 2, respectively. The locations of the pilonidal sinus were similar in the two groups. No statistically significant differences were found in the duration of hospital stay, duration of the procedure, time to return to work, and complication rates between the two groups. Nevertheless, duration of wound healing was 6.1 ± 2.3 and 4.1 ± 0.9 weeks in groups 1 and 2, respectively, and was shorter in group 2. Duration of wound healing was statistically significantly different in the two groups. We concluded in this study that application of platelet-rich plasma in addition to laser pilonidoplasty significantly shortens the time of wound healing.", "provenance": [ { "field": "n", "quote": "Among the 50 patients included in the study" }, { "field": "population", "quote": "Twenty-five patients who were treated by laser pilonidoplasty for pilonidal sinus (group 1) and 25 patients who were treated by platelet-rich plasma in addition to laser pilonidoplasty (group 2) at this clinic were included in the study." }, { "field": "intervention", "quote": "platelet-rich plasma in addition to laser pilonidoplasty" }, { "field": "comparator", "quote": "laser pilonidoplasty for pilonidal sinus (group 1)" }, { "field": "primaryOutcome", "quote": "Duration of stay of the patients in the hospital, time to start daily activities, duration of wound healing, recurrence, and complications were evaluated." }, { "field": "result", "quote": "duration of wound healing was 6.1 ± 2.3 and 4.1 ± 0.9 weeks in groups 1 and 2, respectively, and was shorter in group 2" }, { "field": "result", "quote": "No statistically significant differences were found in the duration of hospital stay, duration of the procedure, time to return to work, and complication rates between the two groups." } ] }, { "id": "pmid:32671004", "pmid": "32671004", "doi": "10.3389/fped.2020.00345", "nctId": null, "pmcid": "PMC7326782", "title": "Pediatric Endoscopic Pilonidal Sinus Treatment (PEPSiT) in Children With Pilonidal Sinus Disease: Tips and Tricks and New Structurated Protocol", "firstAuthor": "Esposito", "multipleAuthors": true, "journal": "Front Pediatr", "year": 2020, "design": "retrospective", "n": 127, "nField": "reported", "population": "children and teenagers with pilonidal sinus disease having endoscopic surgery", "intervention": "endoscopic pilonidal surgery plus laser hair removal with an oxygen-enriched oil gel wound dressing (Group 1)", "comparator": "endoscopic pilonidal surgery plus laser hair removal with a silver sulfadiazine spray wound dressing (Group 2)", "primaryOutcome": "surgical success, recurrence, wound healing time and patient satisfaction", "result": "the oxygen-gel dressing group had a higher success rate, lower recurrence, faster healing and higher satisfaction than the silver-spray group", "resultDirection": "benefit", "quality": "low", "qualityWhy": "it is a retrospective, non-randomized comparison of two wound-dressing protocols, and since laser hair removal was given to every patient in both groups, this study cannot show whether laser itself helped.", "directness": "indirect", "limitations": "retrospective, non-randomized design comparing two post-operative dressings; all patients in both groups received laser epilation so its specific contribution cannot be separated from surgery or dressing; patient satisfaction was a subjective score; single-center experience", "followUp": "", "plainFinding": "Oxygen-gel dressing healed faster than spray.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32671004/", "sourceText": "Background: The advent of pediatric endoscopic pilonidal sinus treatment (PEPSiT) has dramatically changed the surgical management of pilonidal sinus disease (PSD) in children and adolescents. This study aimed to report the outcome of our new structurated protocol, including PEPSiT, laser epilation, and oxygen-enriched oil-based gel dressing, for treatment of PSD in pediatric patients and describe tips and tricks of the technique. Methods: We retrospectively reviewed the data of 127 pediatric patients, who underwent PEPSiT for PSD in our institutions over a 36-month period. All patients received laser epilation (LE) before and after surgery. Post-operative dressing was performed using silver sulfadiazine spray and in the last 18 months oxygen-enriched oil-based gel. We divided the patients in two groups according to the protocol adopted: G1 (laser + oxygen-enriched oil-based gel dressing) included 72 patients and G2 (laser + silver sulfadiazine spray dressing) included 55 patients. The two groups were compared regarding success rate, recurrence, wound infection rate, wound healing time, post-operative outcome, time to full daily activities and patient satisfaction. Results: No difference emerged between the two groups regarding the average operative time, the average post-operative pain score, the average analgesic requirement, the average hospitalization and the average time to full daily activities (p = 0.33). No intra- or post-operative complications including wound infection occurred in both groups. The patients required an average number of 7 LE sessions (range 4-10) to achieve complete hair removal. The overall success rate was significantly higher in G1 (n = 71, 98.6%) compared with G2 (n = 50, 90.9%) [p = 0.001]. The recurrence rate was also significantly lower in G1 (n = 1, 1.4%) compared with G2 (n = 5, 9%) [p = 0.001]. Furthermore, G1 reported a faster wound healing (average 21 days) compared with G2 (average 29 days) [p = 0.001] and a higher patient satisfaction score (average 4.9) compared with G2 (average 4.2) [p = 0.001]. Conclusions: Based upon our experience, PEPSiT may be considered the standard of care for surgical treatment of PSD in children and adolescents. Our new structurated protocol consisting of pre-operative LE, PEPSiT, and post-operative wound management with oxygen-enriched oil-based gel dressing and LE, allowed to achieve an excellent outcome, with a success rate > 98%.", "provenance": [ { "field": "n", "quote": "We retrospectively reviewed the data of 127 pediatric patients" }, { "field": "population", "quote": "127 pediatric patients, who underwent PEPSiT for PSD in our institutions over a 36-month period" }, { "field": "intervention", "quote": "G1 (laser + oxygen-enriched oil-based gel dressing) included 72 patients" }, { "field": "comparator", "quote": "G2 (laser + silver sulfadiazine spray dressing) included 55 patients" }, { "field": "primaryOutcome", "quote": "success rate, recurrence, wound infection rate, wound healing time, post-operative outcome, time to full daily activities and patient satisfaction" }, { "field": "result", "quote": "The overall success rate was significantly higher in G1 (n = 71, 98.6%) compared with G2 (n = 50, 90.9%) [p = 0.001]." } ] }, { "id": "pmid:32302208", "pmid": "32302208", "doi": "10.1308/rcsann.2020.0069", "nctId": null, "pmcid": "PMC7591629", "title": "Laser depilation as adjuvant therapy in prevention of recurrence of pilonidal sinus disease: initial experience of a district general hospital in the UK", "firstAuthor": "Liyanage", "multipleAuthors": true, "journal": "Ann R Coll Surg Engl", "year": 2020, "design": "prospective-cohort", "n": 57, "nField": "reported", "population": "patients who had surgery for pilonidal sinus disease", "intervention": "laser hair removal after surgery to prevent recurrence", "comparator": "no direct comparator group described", "primaryOutcome": "disease recurrence after one year", "result": "12% recurrence rate, with more laser sessions linked to better outcomes", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a single-group study without a comparison group, so it can't firmly prove laser treatment caused the improvement.", "directness": "direct", "limitations": "No control group for comparison; abstract notes need for further high-quality controlled trials.", "followUp": "172 weeks", "plainFinding": "Fewer recurrences with more laser sessions.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32302208/", "sourceText": "INTRODUCTION: Pilonidal disease is a chronic condition involving the sacrococcygeal area. It can have a significant impact on quality of life, social activities and occupation. Surgery is the mainstay of treatment. However, laser depilation has been proposed as an adjunct to surgery and has shown improved results in some studies. We present our experience of laser depilation in the treatment of pilonidal disease in a district general hospital setting in the UK. MATERIALS AND METHODS: A prospectively maintained database of all consecutive patients who received laser depilation after elective surgery for pilonidal disease was analysed. Patients were offered a minimum of two sessions of laser depilation. The primary outcome measure was disease recurrence. Evidence of new symptoms or signs of pilonidal disease after one year from the latest surgical intervention was defined as recurrent disease. Data are presented as medians with interquartile ranges. RESULTS: A total of 64 patients underwent laser depilation after elective surgery between 1 June 2013 and 1 June 2018; 57 were eligible for final analysis. Sixty-five per cent of patients received six or more sessions of laser treatment. There were no short- or long-term complications related to laser depilation. Patients who had more than two sessions of laser depilation showed an improved recurrence rate. Overall, recurrence rate in our series was 12% at a median follow-up of 172 weeks. CONCLUSION: Laser depilation is a safe and effective adjunct to surgery in minimising the recurrence of pilonidal disease. Patients with primary pilonidal disease and those who are undergoing minimally invasive surgery may also benefit from adjuvant laser depilation. Further high-quality control trials are required to assess its efficacy and safety.", "provenance": [ { "field": "n", "quote": "57 were eligible for final analysis" }, { "field": "population", "quote": "all consecutive patients who received laser depilation after elective surgery for pilonidal disease" }, { "field": "intervention", "quote": "laser depilation after elective surgery for pilonidal disease" }, { "field": "comparator", "quote": "Patients who had more than two sessions of laser depilation showed an improved recurrence rate." }, { "field": "primaryOutcome", "quote": "The primary outcome measure was disease recurrence." }, { "field": "result", "quote": "recurrence rate in our series was 12% at a median follow-up of 172 weeks" } ] }, { "id": "pmid:32064640", "pmid": "32064640", "doi": "10.1002/lsm.23224", "nctId": null, "pmcid": null, "title": "Outcomes of Two Treatments for Uncomplicated Pilonidal Sinus Disease: Karydakis Flap Procedure and Sinus Tract Ablation Procedure Using a 1,470 nm Diode Laser Combined With Pit Excision", "firstAuthor": "Yardimci", "multipleAuthors": false, "journal": "Lasers Surg Med", "year": 2020, "design": "rct", "n": 58, "nField": "reported", "population": "patients with uncomplicated early-stage pilonidal sinus disease", "intervention": "pit excision combined with sinus tract ablation using a 1,470 nm diode laser", "comparator": "Karydakis flap surgery", "primaryOutcome": "operative time, pain, recovery time, satisfaction, and recurrence", "result": "Laser treatment had shorter operative time, faster return to activity, less pain, and higher satisfaction, with similar recurrence rates", "resultDirection": "benefit", "quality": "low", "qualityWhy": "Small randomized trial with short follow-up and no blinding described, so results may not hold up in larger studies", "directness": "direct", "limitations": "Small sample size; abstract does not report follow-up duration or blinding methods", "followUp": "", "plainFinding": "Faster recovery, less pain with laser", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32064640/", "sourceText": "BACKGROUND AND OBJECTIVES: An ideal treatment for pilonidal disease should feature a low recurrence rate, minimal incision, and rapid return to daily activities. We compared the outcomes of the well-defined Karydakis technique (KT) and a combination of pit excision (PE) and sinus tract ablation using 1,470-nm diode laser. STUDY DESIGN/MATERIALS AND METHODS: In this study, from January 2016 to January 2018, patients diagnosed with uncomplicated early-stage pilonidal sinus disease were enrolled and were treated randomly, using KT (n = 28) or a PE/laser ablation technique (PE + LAT; n = 30). RESULTS: The mean operative times were 36.4 (25-45) minutes in the KT group and 15.1 (12-20) minutes in the PE + LAT group. Postoperative Visual Analog Scale pain scores were 4.4 in the KT group and 2.1 in the PE + LAT group. The time periods to return to normal daily activities were 2.6 (1-5) days in the PE + LAT group and 12.8 (10-20) days in the KT group. The mean Likert satisfaction scores were 3.8 in the KT group and 4.8 in the PE + LAT group. The groups did not differ in terms of recurrence. CONCLUSIONS: Compared with the KT, the PE + LAT was associated with a shorter operative time, a more rapid return to normal activities, less pain, and a higher level of subjective satisfaction. We found that the PE + LAT was better than the KT for patients with early-stage disease. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.", "provenance": [ { "field": "n", "quote": "treated randomly, using KT (n = 28) or a PE/laser ablation technique (PE + LAT; n = 30)" }, { "field": "population", "quote": "patients diagnosed with uncomplicated early-stage pilonidal sinus disease" }, { "field": "intervention", "quote": "a combination of pit excision (PE) and sinus tract ablation using 1,470-nm diode laser" }, { "field": "comparator", "quote": "the well-defined Karydakis technique (KT)" }, { "field": "primaryOutcome", "quote": "The mean operative times were 36.4 (25-45) minutes in the KT group and 15.1 (12-20) minutes in the PE + LAT group." }, { "field": "result", "quote": "Compared with the KT, the PE + LAT was associated with a shorter operative time, a more rapid return to normal activities, less pain, and a higher level of subjective satisfaction." }, { "field": "result", "quote": "The groups did not differ in terms of recurrence." } ] }, { "id": "pmid:31948600", "pmid": "31948600", "doi": "10.1016/j.bj.2019.12.001", "nctId": null, "pmcid": "PMC6962754", "title": "The body's integrated repair kit: Studying mesenchymal stem cells for better ligament repair", "firstAuthor": "Häfner", "multipleAuthors": false, "journal": "Biomed J", "year": 2019, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "patients having pilonidal sinus surgery", "intervention": "platelet-enriched plasma gel (not laser)", "comparator": "", "primaryOutcome": "wound healing after surgery", "result": "plasma gel treatment significantly improved wound healing", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a brief editorial mention of another study with no details on methods, sample size, or design, so it cannot be judged reliable.", "directness": "indirect", "limitations": "The abstract is an editorial overview of several unrelated studies; it gives no information on study design, population size, or methodology, and the mentioned treatment is a plasma gel, not laser therapy, and the mentioned laser use is for an unrelated condition (twin-twin transfusion syndrome), not pilonidal cysts.", "followUp": "", "plainFinding": "Plasma gel, not laser, helped healing", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/31948600/", "sourceText": "In this issue of the Biomedical Journal, we learn that the sport injury-prone knee ligaments might harbour their own repair kit in the form of mesenchymal stem cells, and that TERT transformation helps to keep these cells longer in culture for more extensive studies. In addition, we get a demonstration that diffusion tensor imaging can reliably show the activity of specific neural circuits, that rheumatoid arthritis patients are more prone to insulin resistance, and that platelet-enriched plasma gels significantly improve wound healing after pilonidal sinus surgery. Furthermore, two procreation-related articles inform us that growth hormone treatment improves endometrial receptivity in older women, and that elevated maternal liver enzymes do not impact on the outcome of laser therapy for twin-twin transfusion syndrome. Finally, our attention is brought to the importance of subjective well-being evaluation for orthodontic correction needs, as well as the possibility that exercise could maybe increase sperm telomere length.", "provenance": [ { "field": "population", "quote": "pilonidal sinus surgery" }, { "field": "intervention", "quote": "platelet-enriched plasma gels" }, { "field": "primaryOutcome", "quote": "wound healing after pilonidal sinus surgery" }, { "field": "result", "quote": "platelet-enriched plasma gels significantly improve wound healing after pilonidal sinus surgery" } ] }, { "id": "pmid:31773347", "pmid": "31773347", "doi": "10.1007/s10151-019-02119-2", "nctId": null, "pmcid": null, "title": "The SiLaC procedure for pilonidal sinus disease: long-term outcomes of a single institution prospective study", "firstAuthor": "Dessily", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2019, "design": "prospective-cohort", "n": 200, "nField": "reported", "population": "patients with pilonidal sinus disease (first-time, not recurrent)", "intervention": "SiLaC procedure (sinus laser-assisted closure) for pilonidal sinus", "comparator": "none - single-arm study, no control group", "primaryOutcome": "wound healing and recurrence rates", "result": "94% healing rate with mean healing time of 19.5 days; 14.9% recurrence rate at long-term follow-up", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a single-arm study with no comparison group, so it cannot show whether laser treatment works better than other options, and only 77.5% of patients responded to the long-term recurrence survey.", "directness": "direct", "limitations": "No control/comparator group; recurrence data relied on patient-reported mail/phone survey with 77.5% response rate; single institution.", "followUp": "", "plainFinding": "High healing rate, some recurrence", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/31773347/", "sourceText": "BACKGROUND: In 2014, we started to treat pilonidal sinus disease in our institution with sinus laser-assisted closure (SiLaC) procedure. The aim of the present study was to evaluate the safety and efficacy of the SiLaC procedure in a single institution prospective study on a large cohort of patients and with a long follow-up period, and try to determine what factors that could influence healing and recurrence. METHODS: A prospective study was conducted on consecutive patients with primary pilonidal sinus disease operated on with the SiLaC procedure at our institution from March 2015 to August 2017. Demographic and surgical data, outcomes, and complications were prospectively recorded and compared between the healed and not healed/recurrence groups to find factors influencing healing. Postoperative follow-up was performed in the outpatient clinic every 2 weeks for 2 months. In March 2018, patients were questioned by mail or phone to assess long-term recurrences. RESULTS: There were 200 patients. The healing rate was high (94%) with a mean healing time of 19.5 ± 14.4 days. Mean operative time (9.4 ± 2.6 min) and mean duration of postoperative analgesic therapy (4.72 ± 5.64 days) were short. Postoperative complications (15%) were mainly infection (9.5%). There was a response rate of 77.5% to mail/phone questionnaires about recurrence. The recurrence rate was 14.9%. Mean time until recurrence was 193.5 ± 87.19 days. The incidence of secondary openings, complications, and infection in the healing vs not healed or recurrence groups, was 24.8% vs 56.6%, 19.2% vs 40%, and 8.8% vs 30%, respectively. CONCLUSIONS: SiLaC is an effective, easy to perform, reproducible, and almost painless procedure. Factors influencing healing seem to be the presence of secondary openings, postoperative complications, and, especially, infection. The SiLaC procedure could become one of the treatments of choice for pilonidal sinus disease.", "provenance": [ { "field": "population", "quote": "consecutive patients with primary pilonidal sinus disease" }, { "field": "intervention", "quote": "sinus laser-assisted closure (SiLaC) procedure" }, { "field": "comparator", "quote": "A prospective study was conducted on consecutive patients with primary pilonidal sinus disease operated on with the SiLaC procedure" }, { "field": "primaryOutcome", "quote": "try to determine what factors that could influence healing and recurrence" }, { "field": "result", "quote": "The healing rate was high (94%) with a mean healing time of 19.5 ± 14.4 days." }, { "field": "result", "quote": "The recurrence rate was 14.9%." }, { "field": "n", "quote": "There were 200 patients." } ] }, { "id": "pmid:31676078", "pmid": "31676078", "doi": "10.1016/j.jpedsurg.2019.09.074", "nctId": null, "pmcid": null, "title": "Improving Resource Utilization and Outcomes Using a Minimally Invasive Pilonidal Protocol", "firstAuthor": "Delshad", "multipleAuthors": true, "journal": "J Pediatr Surg", "year": 2020, "design": "retrospective", "n": 51, "nField": "reported", "population": "adolescents with moderate to severe pilonidal disease", "intervention": "minimally invasive pilonidal protocol (improved hygiene, laser epilation, and sinusectomy)", "comparator": "surgical excision", "primaryOutcome": "healed or asymptomatic status at last follow-up, plus resource use (visits, OR time, charges)", "result": "82% of minimally invasive protocol patients were healed or asymptomatic versus 18% of surgical excision patients, with lower charges", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small retrospective comparison with a historical control group, not a randomized trial, so bias is likely.", "directness": "direct", "limitations": "Retrospective comparative study comparing a historical surgical excision cohort to a later minimally invasive protocol cohort; small sample size.", "followUp": "", "plainFinding": "Better healing, lower cost than surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/31676078/", "sourceText": "PURPOSE: The purpose of this study was to evaluate the resource utilization and outcome of a minimally invasive pilonidal protocol (MIPP) versus surgical excision (SE) in adolescents with pilonidal disease. METHODS: Improved hygiene, laser epilation (LE), and sinusectomy were implemented as a minimally invasive pilonidal protocol (MIPP) in March 2016. Following IRB approval, 34 consecutive MIPP patients with moderate and severe disease were compared with a random sample of 17 SE patients treated prior to MIPP implementation. Number of visits, laser epilation (LE) treatments, care duration, operations, operating room (OR) time, charges, and condition at last visit were analyzed. Charges were standardized for 2018. RESULTS: No differences were found in age or body mass index between groups. SE patients underwent an average 1.6 excisions/patient (cumulative 2598 OR minutes) and no LE. MIPP patients underwent an average 1.4 sinusectomies and 3.5 LEs/patient. Six sinusectomies (0.17/patient) were performed in OR (cumulative 258 OR minutes). No differences in number of visits or care duration were found between groups. At last follow-up, 82% of MIPP and 18% of SE patients were healed or asymptomatic (p < 0.01). Average charges were $29,098 for SE versus $8440 for MIPP (p < 0.01). CONCLUSION: A minimally invasive pilonidal protocol reduces charges and improves outcome compared with surgical excision in adolescents. LEVEL OF EVIDENCE: III. TYPE OF STUDY: Retrospective comparative study.", "provenance": [ { "field": "n", "quote": "34 consecutive MIPP patients with moderate and severe disease were compared with a random sample of 17 SE patients" }, { "field": "population", "quote": "adolescents with pilonidal disease" }, { "field": "intervention", "quote": "Improved hygiene, laser epilation (LE), and sinusectomy were implemented as a minimally invasive pilonidal protocol (MIPP)" }, { "field": "comparator", "quote": "versus surgical excision (SE)" }, { "field": "primaryOutcome", "quote": "Number of visits, laser epilation (LE) treatments, care duration, operations, operating room (OR) time, charges, and condition at last visit were analyzed." }, { "field": "result", "quote": "At last follow-up, 82% of MIPP and 18% of SE patients were healed or asymptomatic (p < 0.01). Average charges were $29,098 for SE versus $8440 for MIPP (p < 0.01)." } ] }, { "id": "pmid:31435733", "pmid": "31435733", "doi": "10.1007/s00384-019-03366-3", "nctId": null, "pmcid": null, "title": "A hairy cavity: endoscopic therapy of a presacral recurrence of a complex pilonidal sinus", "firstAuthor": "Noorah", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2019, "design": "case-series", "n": 1, "nField": "reported", "population": "adult man with a complicated, recurrent pilonidal sinus that had spread deep into the pelvis after five prior surgeries", "intervention": "flexible endoscopic treatment combining cleaning, laser ablation (APC), and vacuum therapy", "comparator": "his own history of prior open surgical resections", "primaryOutcome": "whether the sinus healed without recurring", "result": "no recurrence two years after treatment", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show whether this works in general.", "directness": "indirect", "limitations": "only one patient, no comparison group, and the case was unusually complex and atypical.", "followUp": "Two years", "plainFinding": "No recurrence after two years.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/31435733/", "sourceText": "BACKGROUND: Recently, minimally invasive techniques to avoid radical excisions of the pilonidal sinus with long-lasting secondary wound healing were developed. We describe a rare case of an intrapelvic, pararectal recurrence of a pilonidal sinus, who was innovatively treated with flexible endoscopy. CASE PRESENTATION: A 43-year-old Caucasian man presented with an intrapelvic, pararectal recurrence of a primarily wide-stretched pilonidal sinus, originally located in the sacrococcygeal region and spreading laterally to the gluteal region and intrapelvic to the presacral area. No connection to the bowel was evident. Up until presentation in the endoscopic department, a total of five attempts of surgical resection were performed, always confirming the diagnosis of a pilonidal sinus. Endoscopic therapy consisted of a combination of debridement, laser ablation and endoscopic vacuum therapy. After completion of APC and VAC therapy, the patient irrigated the abscess cavity for a further 2 weeks with a rinsing syringe. The resulting deep scar at the gluteal fistula was resected after secondary wound healing was completed. Two years after the end of the therapy, no recurrence was evident. CONCLUSION: Flexible endoscopy is, with its multiple therapeutic applications, an effective tool even in very complex inflammatory fistula and abscesses. Correctly indicated, it is with its minimally invasive character an excellent alternative to open surgical approaches.", "provenance": [ { "field": "population", "quote": "A 43-year-old Caucasian man presented with an intrapelvic, pararectal recurrence of a primarily wide-stretched pilonidal sinus" }, { "field": "n", "quote": "A 43-year-old Caucasian man" }, { "field": "intervention", "quote": "Endoscopic therapy consisted of a combination of debridement, laser ablation and endoscopic vacuum therapy." }, { "field": "comparator", "quote": "a total of five attempts of surgical resection were performed, always confirming the diagnosis of a pilonidal sinus" }, { "field": "primaryOutcome", "quote": "Two years after the end of the therapy, no recurrence was evident." }, { "field": "result", "quote": "Two years after the end of the therapy, no recurrence was evident." } ] }, { "id": "pmid:31126689", "pmid": "31126689", "doi": "10.1016/j.jpedsurg.2019.04.031", "nctId": null, "pmcid": null, "title": "Technical standardization of MIS management of children with pilonidal sinus disease using pediatric endoscopic pilonidal sinus treatment (PEPSiT) and laser epilation", "firstAuthor": "Esposito", "multipleAuthors": true, "journal": "J Pediatr Surg", "year": 2020, "design": "case-series", "n": 59, "nField": "reported", "population": "children with pilonidal sinus disease (acute or chronic)", "intervention": "endoscopic pilonidal sinus surgery (PEPSiT) combined with laser hair removal before and after surgery", "comparator": "none (single group, no comparison treatment)", "primaryOutcome": "healing of the wound and recurrence of the cyst after treatment", "result": "all wounds healed by 1 month, with only 1 recurrence (1.6%) during follow-up", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a small single-group study without a comparison group, so it cannot show whether laser added any benefit over surgery alone.", "directness": "indirect", "limitations": "no control group, single center, level IV evidence, laser epilation only used in the last 15 months of the study period", "followUp": "1 month", "plainFinding": "Nearly all wounds healed, low recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/31126689/", "sourceText": "PURPOSE: This study aimed to standardize the technique of pediatric endoscopic pilonidal sinus treatment (PEPSiT) associated with laser epilation. METHODS: All pediatric patients presenting with acute or chronic pilonidal sinus disease (PSD) who underwent PEPSiT in our institution over a 36-month period (July 2015-July 2018), were included in the study. Pre- and postoperative management, recurrence rate, postoperative pain, hospital stay, analgesic requirements, and patient satisfaction levels were evaluated. RESULTS: A total of 59 patients (23 girls and 36 boys) underwent PEPSiT during the study period. Ten/59 patients (16.9%) had recurrent PSD after open repair, and 4/59 (6.7%) presented a concomitant pilonidal cyst. All children underwent laser epilation pre- and postoperatively over the last 15 months. The average length of surgery was 27.5 min (range 20-45). The average pain score during the first 48 postoperative hours was 2.7 (range 2-5), and the average analgesic requirement was 20 h (range 16-24). The average hospitalization was 22.4 h (range 18-36). At 1 month postoperatively, external openings were healed in all patients. During follow-up, 1 recurrence (1.6%) was recorded and successfully re-treated with PEPSiT. CONCLUSIONS: We believe that PEPSiT represents the technique of choice for treatment of PSD in the pediatric population. It is crucial to standardize the technique consisting of pre- and postoperative laser epilation, PEPSiT, and accurate postoperative wound management with eosin and sulfadiazine spray. LEVEL OF EVIDENCE: Treatment study - Level IV.", "provenance": [ { "field": "n", "quote": "A total of 59 patients (23 girls and 36 boys) underwent PEPSiT during the study period." }, { "field": "population", "quote": "All pediatric patients presenting with acute or chronic pilonidal sinus disease (PSD) who underwent PEPSiT in our institution" }, { "field": "intervention", "quote": "All children underwent laser epilation pre- and postoperatively over the last 15 months." }, { "field": "intervention", "quote": "pediatric endoscopic pilonidal sinus treatment (PEPSiT) associated with laser epilation" }, { "field": "comparator", "quote": "This study aimed to standardize the technique of pediatric endoscopic pilonidal sinus treatment (PEPSiT) associated with laser epilation." }, { "field": "primaryOutcome", "quote": "Pre- and postoperative management, recurrence rate, postoperative pain, hospital stay, analgesic requirements, and patient satisfaction levels were evaluated." }, { "field": "result", "quote": "At 1 month postoperatively, external openings were healed in all patients. During follow-up, 1 recurrence (1.6%) was recorded and successfully re-treated with PEPSiT." } ] }, { "id": "pmid:31120213", "pmid": "31120213", "doi": null, "nctId": null, "pmcid": null, "title": "[Chronic pilonidal sinus disease: overview of treatment options]", "firstAuthor": "Pronk", "multipleAuthors": true, "journal": "Ned Tijdschr Geneeskd", "year": 2019, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with chronic pilonidal sinus disease, mostly young men", "intervention": "minimally invasive treatments such as laser (including laser hair removal)", "comparator": "standard excision with primary or secondary wound healing, and other techniques like phenolisation or flap surgery", "primaryOutcome": "pain, wound healing speed, return to work, and recurrence of pilonidal sinus disease", "result": "minimally invasive techniques including laser are associated with less pain and faster healing, and laser hair removal after surgery appears to lower recurrence risk", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a general overview article describing treatment options without presenting original study data, numbers of patients, or statistical results.", "directness": "direct", "limitations": "no participant numbers, study design details, or statistical results are given; it is a narrative overview rather than a controlled study.", "followUp": "", "plainFinding": "May reduce pain and recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/31120213/", "sourceText": "Chronic pilonidal sinus disease: overview of treatment options Pilonidal sinus disease is a common disease in predominantly young men; this condition can have a significant socio-economic impact. Although excision with primary or secondary wound healing is often applied, there is no consensus on the treatment of first choice for pilonidal sinus disease. Minimally invasive techniques, such as phenolisation, laser, and endoscopic treatments are increasingly applied, since these are associated with less pain, faster wound healing and facilitating a more rapid return to work for patients. Skin advancement flap techniques, considering they cause morbidity and large wounds, should only be considered in case of recurrent pilonidal sinus disease. Laser hair removal at the natal cleft after surgical treatment appears to reduce the risk of recurrence.", "provenance": [ { "field": "population", "quote": "Pilonidal sinus disease is a common disease in predominantly young men" }, { "field": "intervention", "quote": "Minimally invasive techniques, such as phenolisation, laser, and endoscopic treatments are increasingly applied" }, { "field": "comparator", "quote": "excision with primary or secondary wound healing is often applied" }, { "field": "primaryOutcome", "quote": "less pain, faster wound healing and facilitating a more rapid return to work for patients" }, { "field": "result", "quote": "Laser hair removal at the natal cleft after surgical treatment appears to reduce the risk of recurrence." } ] }, { "id": "pmid:31117133", "pmid": "31117133", "doi": "10.1055/a-0901-7945", "nctId": null, "pmcid": null, "title": "[Pilonidal Sinus Disease; What is the Best Treatment Option?]", "firstAuthor": "Petersen", "multipleAuthors": false, "journal": "Zentralbl Chir", "year": 2019, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "People with chronic pilonidal sinus disease (infection of hairy skin near the tailbone)", "intervention": "Minimally invasive, skin-preserving treatments including pit picking, fistuloscopy, phenol injection, and laser treatment", "comparator": "Standard excision with open wound healing, and excision with plastic reconstruction", "primaryOutcome": "Treatment outcomes including recurrence rate, wound healing, and long-term results", "result": "The abstract states that for laser and other newer destructive treatments, final evaluation of results is still pending, with no specific outcome data given", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a general narrative review that only mentions laser treatment in passing without presenting any specific study data or outcomes for it.", "directness": "direct", "limitations": "The abstract does not report any study design, patient numbers, or outcome data specific to laser treatment; it is a general overview of pilonidal disease treatments.", "followUp": "", "plainFinding": "Laser results not yet established.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/31117133/", "sourceText": "INTRODUCTION: Sinus pilonidalis is a chronic infection of the hairy skin in the area of skin wrinkles, with the most common localization in the natal cleft. The disease often has a significant impact on the quality of life of the affected person; the treatment may be complex and needs to be adapted to the patient's needs. METHODS: Below is an overview of the origin as well as the treatment alternatives and their peculiarities. The following aspects are presented: early post-operative results, wound healing disorder and long-term results. RESULTS: The pathomechanism of pilonidal sinus disease has still not been conclusively clarified; it must continue to be assumed that the hair in the natal cleft contributes significantly to the formation. However, recent findings indicate that the large tufts of hair that are repeatedly found in the wound cavity are most likely to come from the hairy scalp. Three essential treatment options can be distinguished: The standard treatment of excision and subsequent open wound treatment, has a low recurrence rate, but requires considerable effort in wound treatment and thus leads to protracted time off work. Relatively new treatments include locally destructive treatment that essentially preserves the skin. Important representatives are so-called pit picking, fistuloscopy and other forms of treatment, such as phenol injection and/or laser treatment. In these treatment options, the final evaluation of the results is still pending. The third treatment group is excision and plastic reconstruction. These procedures are technically demanding, often involve inpatient treatment but lead to relatively good results in the long term. CONCLUSION: Treatment of pilonidal disease requires patient-oriented therapy planning. The patient must be taught the different treatment options and a treatment recommendation must be given to the patient. Excision and open granulation continues to serve as a standard procedure with which other treatment options can be compared.", "provenance": [ { "field": "population", "quote": "Sinus pilonidalis is a chronic infection of the hairy skin in the area of skin wrinkles, with the most common localization in the natal cleft." }, { "field": "intervention", "quote": "so-called pit picking, fistuloscopy and other forms of treatment, such as phenol injection and/or laser treatment" }, { "field": "comparator", "quote": "The standard treatment of excision and subsequent open wound treatment, has a low recurrence rate" }, { "field": "primaryOutcome", "quote": "early post-operative results, wound healing disorder and long-term results" }, { "field": "result", "quote": "In these treatment options, the final evaluation of the results is still pending." } ] }, { "id": "pmid:30782310", "pmid": "30782310", "doi": "10.3238/arztebl.2019.0012", "nctId": null, "pmcid": "PMC6384517", "title": "The Management of Pilonidal Sinus", "firstAuthor": "Iesalnieks", "multipleAuthors": true, "journal": "Dtsch Arztebl Int", "year": 2019, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus disease (infection near the tailbone)", "intervention": "minimally invasive techniques, including laser treatment", "comparator": "excisional surgical methods (such as off-midline closure techniques)", "primaryOutcome": "recurrence rate of pilonidal disease", "result": "not clear whether laser or endoscopic techniques lower the chance of the cyst coming back", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a general narrative review of the literature rather than a controlled study specifically testing laser treatment, and it explicitly says the evidence is not yet clear.", "directness": "direct", "limitations": "The review states further randomized trials are needed to clarify the role of newer techniques; no specific data on laser outcomes are given.", "followUp": "", "plainFinding": "Unclear if laser lowers recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30782310/", "sourceText": "BACKGROUND: Pilonidal disease is an acute or chronic infection in the subcutaneous fatty tissue, mainly in the natal cleft. Its incidence in Germany in 2012 was 48 cases per 100 000 persons per year. METHODS: This review is based on pertinent publications retrieved by a selective literature search. RESULTS: The numerous minimally invasive techniques that are available for the treatment of pilonidal disease have the advantages of being relatively atraumatic and of enabling the patient to continue working almost without interruption. They are suitable for small lesions that have not been previously surgically treated. These techniques are associated with a higher recurrence rate than excisional methods (level of evidence [LoE]: Ib). It is not yet clear whether minimally invasive techniques employing laser or endoscopic technology can reduce the recurrence rate. In systematic meta-analyses, the duration of wound healing was shorter after off-midline techniques (the Karydakis procedure, the Limberg procedure, and others) than after excision with open wound treatment; the off-midline techniques should, therefore, be preferred for patients who have undergone previous surgery and for those with large lesions (LoE: Ia). Excision with midline suturing should not be performed (LoE: Ia). Postoperative permanent shaving cannot be recommended either (LoE: IV). CONCLUSION: Further randomized trials are needed to clarify the role of newer techniques in the treatment of pilonidal disease.", "provenance": [ { "field": "population", "quote": "Pilonidal disease is an acute or chronic infection in the subcutaneous fatty tissue, mainly in the natal cleft." }, { "field": "intervention", "quote": "minimally invasive techniques employing laser or endoscopic technology" }, { "field": "comparator", "quote": "excisional methods" }, { "field": "primaryOutcome", "quote": "reduce the recurrence rate" }, { "field": "result", "quote": "It is not yet clear whether minimally invasive techniques employing laser or endoscopic technology can reduce the recurrence rate." } ] }, { "id": "pmid:30661599", "pmid": "30661599", "doi": "10.1016/j.jpedsurg.2018.10.021", "nctId": null, "pmcid": null, "title": "Pit-picking resolves pilonidal disease in adolescents", "firstAuthor": "Delshad", "multipleAuthors": true, "journal": "J Pediatr Surg", "year": 2019, "design": "case-series", "n": 58, "nField": "reported", "population": "adolescents and young adults with pilonidal disease", "intervention": "pit-picking procedure (with laser hair removal added for hairy patients)", "comparator": "none (single-group case series, no comparison group)", "primaryOutcome": "whether patients became symptom-free after the procedure", "result": "92% of patients with follow-up data were symptom-free at an average of 5 months", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a small, uncontrolled case series where laser hair removal was just one added step for some patients, not the main treatment being tested, so it can't show whether laser itself works.", "directness": "indirect", "limitations": "No control group, 12% lost to follow-up, short follow-up, and laser was only used as an adjunct for hair removal in some patients rather than as the primary treatment studied.", "followUp": "5.0 months (range 1-20)", "plainFinding": "Mainly tests pit-picking, not laser treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30661599/", "sourceText": "PURPOSE: The purpose of the study was to evaluate the outcome of pit-picking on adolescents with pilonidal disease. METHODS: Patients presenting to a Pilonidal Clinic were managed by evacuation of any un-drained collections, soaking, and as needed, hair removal. Once active inflammation resolved, they underwent pit-picking under local anesthesia. Those with >3 pits underwent sequential pit-pickings 2 months apart. Hirsute patients also underwent laser hair epilation. Pilonidal disease was stratified by severity. Patient symptoms were collected prospectively and reviewed. RESULTS: Fifty-eight patients underwent at least one pit-picking from February 2016 to September 2017. There were 40 (69%) males with a mean age of 17.7 years (range 13-24). Thirty-seven hirsute patients (64%) underwent a series of laser epilation treatments. Patients required from 0 to 3 days of non-narcotic analgesia, and all returned promptly to pre-procedure activities. Seven patients (12%) were lost to follow-up. Of the 51 patients with follow-up data, 47 (92%) were symptom-free an average of 5.0 months (range 1-20) post-procedure. Four patients (8%) had persistent intermittent drainage. CONCLUSION: Pit-picking is a simple office procedure that may resolve pilonidal disease in many adolescents. A longer follow-up interval is needed to determine the long-term recurrence rate. TYPE OF STUDY: Case Series. LEVEL OF EVIDENCE: Level IV.", "provenance": [ { "field": "n", "quote": "Fifty-eight patients underwent at least one pit-picking from February 2016 to September 2017." }, { "field": "population", "quote": "The purpose of the study was to evaluate the outcome of pit-picking on adolescents with pilonidal disease." }, { "field": "intervention", "quote": "Hirsute patients also underwent laser hair epilation." }, { "field": "intervention", "quote": "they underwent pit-picking under local anesthesia" }, { "field": "comparator", "quote": "TYPE OF STUDY: Case Series." }, { "field": "primaryOutcome", "quote": "Of the 51 patients with follow-up data, 47 (92%) were symptom-free an average of 5.0 months (range 1-20) post-procedure." }, { "field": "result", "quote": "47 (92%) were symptom-free an average of 5.0 months (range 1-20) post-procedure" } ] }, { "id": "pmid:30489572", "pmid": "30489572", "doi": null, "nctId": null, "pmcid": null, "title": "Treatment options for pilonidal sinus", "firstAuthor": "Kober", "multipleAuthors": true, "journal": "Cutis", "year": 2018, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with chronic pilonidal sinus disease, often hirsute men", "intervention": "various treatments including conservative care, surgery, and laser therapy", "comparator": "different treatment types compared to each other (e.g., primary vs secondary closure, Karydakis vs Limberg flap)", "primaryOutcome": "best approach to managing pilonidal sinus disease, including recurrence and recovery", "result": "off-midline repair is considered standard of care; no significant difference found between some surgical closure methods; laser therapy mentioned as a novel option without specific results given", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a narrative review summarizing other studies without presenting new data or statistics on laser treatment specifically.", "directness": "indirect", "limitations": "abstract does not provide specific data, outcomes, or statistics for laser therapy; it is a general review of multiple treatment types.", "followUp": "", "plainFinding": "Laser benefit unclear from this review.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30489572/", "sourceText": "Pilonidal sinus disease often presents as a chronic problem in otherwise healthy hirsute men. A range of conservative techniques to surgical flaps have been employed to treat this condition. We review the literature on management of pilonidal sinus disease, including conservative and surgical techniques as well as novel laser therapy. Given current evidence, off-midline repair is now considered the standard of care; however, no statistically significant difference has been noted between primary versus secondary closure or between the Karydakis flap and Limberg flap. Treatment should be tailored to the individual, taking into account recurrent disease, recovery time, and the surgeon's comfort with the procedure.", "provenance": [ { "field": "population", "quote": "Pilonidal sinus disease often presents as a chronic problem in otherwise healthy hirsute men." }, { "field": "intervention", "quote": "A range of conservative techniques to surgical flaps have been employed to treat this condition." }, { "field": "intervention", "quote": "as well as novel laser therapy" }, { "field": "comparator", "quote": "no statistically significant difference has been noted between primary versus secondary closure or between the Karydakis flap and Limberg flap" }, { "field": "primaryOutcome", "quote": "We review the literature on management of pilonidal sinus disease" }, { "field": "result", "quote": "Given current evidence, off-midline repair is now considered the standard of care; however, no statistically significant difference has been noted between primary versus secondary closure or between the Karydakis flap and Limberg flap." } ] }, { "id": "pmid:30306277", "pmid": "30306277", "doi": "10.1007/s10151-018-1863-5", "nctId": null, "pmcid": null, "title": "Outpatient laser treatment of primary pilonidal disease : the PiLaT technique", "firstAuthor": "Georgiou", "multipleAuthors": false, "journal": "Tech Coloproctol", "year": 2018, "design": "prospective-cohort", "n": 60, "nField": "reported", "population": "patients with primary (first-time, non-recurrent) pilonidal cyst disease", "intervention": "laser treatment of the cyst and sinus tracts (PiLaT technique) under local anaesthesia, outpatient", "comparator": "none (single-arm, no comparison group)", "primaryOutcome": "complete healing (epithelization) of the cyst and tracts", "result": "92% of patients healed completely, with low pain and high satisfaction", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small, single-group study without a comparison treatment, so it can't show if laser works better than other options.", "directness": "direct", "limitations": "No comparator group; single-arm observational design limits ability to attribute outcomes to the laser itself.", "followUp": "12 months", "plainFinding": "Most cysts healed with laser.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30306277/", "sourceText": "BACKGROUND: The aim of the present study was to assess the effectiveness of the minimally invasive technique pilonidal disease laser treatment (PiLaT) in treating primary (non-recurrent) pilonidal disease in an outpatient setting under local anaesthesia. METHODS: A prospective observational study was conducted on consecutive patients suffering from primary pilonidal disease that were treated at Iasi Private Medical Center, Ioannina, Greece, between April 2015 and December 2016, using a 1.470 nm diode laser (BioLitec, Germany) emitting energy through a radial optic fiber that was inserted in the cyst and accompanying sinus tracts. Patients were discharged half an hour after completion of the procedure. Pain scores [visual analogue scale (VAS)], complications and patient satisfaction were assessed. Follow-up lasted 12 months. RESULTS: There were 60 patients, 51 males and 9 females, with a mean age of 22.7 years (range 15-58). Successful treatment (complete epithelization of cyst and tracts) was documented in 55 out of the 60 patients (92% success rate). VAS pain scores were low and no major complications were recorded. Healing was achieved in 25.4 days (range 17-40) and 53.3% of patients were able to return to work the same day (the rest within 3 days). Of the failures, four patients did not heal and one patient recurred after 5 months. All failures were treated successfully with a second laser procedure except for one who denied re-intervention. Overall patient satisfaction reached 98%. CONCLUSIONS: PiLaT seems to be very close to the ideal treatment of pilonidal disease, since it is safe, easy to perform, almost painless and highly effective.", "provenance": [ { "field": "population", "quote": "consecutive patients suffering from primary pilonidal disease" }, { "field": "intervention", "quote": "minimally invasive technique pilonidal disease laser treatment (PiLaT) in treating primary (non-recurrent) pilonidal disease in an outpatient setting under local anaesthesia" }, { "field": "comparator", "quote": "A prospective observational study was conducted on consecutive patients" }, { "field": "primaryOutcome", "quote": "Successful treatment (complete epithelization of cyst and tracts)" }, { "field": "result", "quote": "Successful treatment (complete epithelization of cyst and tracts) was documented in 55 out of the 60 patients (92% success rate)" }, { "field": "n", "quote": "There were 60 patients, 51 males and 9 females" }, { "field": "followUp", "quote": "Follow-up lasted 12 months." } ] }, { "id": "pmid:30205751", "pmid": "30205751", "doi": "10.1080/00015458.2018.1515337", "nctId": null, "pmcid": null, "title": "Fistula-tract Laser Closure (FiLaC™) for complex urethroperineal fistula", "firstAuthor": "Gys", "multipleAuthors": true, "journal": "Acta Chir Belg", "year": 2018, "design": "case-series", "n": 2, "nField": "reported", "population": "patients with urethroperineal fistula caused by hidradenitis suppurativa", "intervention": "laser closure of the fistula tract (FiLaC)", "comparator": "none (no comparison group)", "primaryOutcome": "closure of the fistula tract", "result": "both patients had complete closure of the fistula tract after 3 months", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "Only two patients were treated with no comparison group, so the results are very uncertain and this abstract is not about pilonidal cysts.", "directness": "indirect", "limitations": "Abstract reports only 2 cases of a different condition (urethroperineal fistula from hidradenitis suppurativa), not pilonidal sinus/cyst disease, with no control group.", "followUp": "3 months", "plainFinding": "Fistula tracts closed completely (different condition).", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30205751/", "sourceText": "BACKGROUND: Fistula formation in hidradenitis suppurativa follows an uncontrolled infection with subcutaneous tracts leading to 'watering-can' or 'pus-pot' perineum. Closure of this type of fistula implies major surgery and is bound to fail in refractory inflammatory environment. Minimally invasive techniques have become the first line of choice in every type of surgery. METHODS: Fistula-tract Laser Closure (FiLaC™, Biolitec, Germany) is a novel technique already reported to have been used in the treatment of fistula-in-ano and pilonidal sinus. It consists of blind cauterization and obliteration of the fistula tract from the inside by means of a radial-emitting laser probe. We present two patients who underwent surgery for urethroperineal fistula using this technique. RESULTS: In both cases, the fistula tracts were completely closed after 3 months of follow-up. The wounds had healed smoothly and complete resolution of symptoms was noted. CONCLUSIONS: The use of FiLaC™ for the treatment of urethroperineal fistula is feasible and safe. The minimally invasive nature of the technique and limited postoperative pain permit daycare surgery.", "provenance": [ { "field": "n", "quote": "We present two patients who underwent surgery for urethroperineal fistula using this technique." }, { "field": "population", "quote": "We present two patients who underwent surgery for urethroperineal fistula using this technique." }, { "field": "intervention", "quote": "Fistula-tract Laser Closure (FiLaC™, Biolitec, Germany) is a novel technique already reported to have been used in the treatment of fistula-in-ano and pilonidal sinus." }, { "field": "comparator", "quote": "We present two patients who underwent surgery for urethroperineal fistula using this technique." }, { "field": "primaryOutcome", "quote": "In both cases, the fistula tracts were completely closed after 3 months of follow-up." }, { "field": "result", "quote": "In both cases, the fistula tracts were completely closed after 3 months of follow-up." } ] }, { "id": "pmid:30104141", "pmid": "30104141", "doi": "10.1016/j.bjps.2018.05.014", "nctId": null, "pmcid": null, "title": "Inferiorly based lotus petal flap & laser therapy in difficult pilonidal sinus management", "firstAuthor": "Hamnett", "multipleAuthors": true, "journal": "J Plast Reconstr Aesthet Surg", "year": 2018, "design": "case-series", "n": 14, "nField": "reported", "population": "patients with difficult, often recurrent pilonidal sinuses treated between 2007 and 2015", "intervention": "lotus petal flap surgery with some patients also receiving Alexandrite laser hair removal", "comparator": "", "primaryOutcome": "recurrence, re-operation, healing time, wound breakdown, discharge, infection, cosmesis and patient comfort", "result": "only 14% had prolonged wound healing and recurrence rates were lower than those in the literature", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a small uncontrolled case series where laser was only one part of combined surgical treatment, so its own effect can't be separated out.", "directness": "indirect", "limitations": "Small sample of 14, no control group, laser used in only half the patients alongside surgery, so the laser's individual contribution to outcomes is not isolated.", "followUp": "", "plainFinding": "Laser's own effect unclear here.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30104141/", "sourceText": "AIM: To assess the efficacy of the lotus petal flap in difficult pilonidal sinus management. BACKGROUND: Pilonidal sinuses may be difficult to treat. Five year recurrence rates range from 18% to 50% Recurrence rates fall with primary closure rather than healing by secondary intention. Techniques such as z-plasty however, distort natal architecture. The lotus petal flap taken from the superior buttock fills dead space whilst conforming to the natural concave appearance of the natal cleft. The contralateral buttock is spared. It is straightforward and reproducible. Multiple perforators make it robust and promote wound healing in this difficult group. METHOD: We present a series of 14 patients who had a lotus petal flap reconstruction following pilonidal sinus excision between 2007 and 2015. The majority of these patients had previous multiple failed attempts at eradication. Recurrence rates, re-operation rates, time for complete healing, wound breakdown, discharge, infection, cosmesis and patient comfort were assessed. RESULTS: Many patients had coarse hair; felt to predispose to recurrence of symptoms, poor hygiene and prolonged wound healing. 50% of patients underwent Alexandrite laser (755 nm wavelength) for a minimum of 6 treatments. There was excellent compliance and good patient outcome. Overall in this complex patient group only 14% had prolonged wound healing and recurrence rates were lower than those in the literature. CONCLUSION: The lotus petal flap is an excellent choice for problematic pilonidal sinus reconstruction. When combined with tumour like excision, meticulous surgical technique and complimentary laser hair removal results can be improved further.", "provenance": [ { "field": "population", "quote": "We present a series of 14 patients who had a lotus petal flap reconstruction following pilonidal sinus excision between 2007 and 2015." }, { "field": "intervention", "quote": "50% of patients underwent Alexandrite laser (755 nm wavelength) for a minimum of 6 treatments." }, { "field": "primaryOutcome", "quote": "Recurrence rates, re-operation rates, time for complete healing, wound breakdown, discharge, infection, cosmesis and patient comfort were assessed." }, { "field": "result", "quote": "Overall in this complex patient group only 14% had prolonged wound healing and recurrence rates were lower than those in the literature." }, { "field": "n", "quote": "We present a series of 14 patients" } ] }, { "id": "pmid:30095368", "pmid": "30095368", "doi": "10.1089/sur.2018.099", "nctId": null, "pmcid": null, "title": "Laser Hair Depilation in the Treatment of Pilonidal Disease: A Systematic Review", "firstAuthor": "Halleran", "multipleAuthors": true, "journal": "Surg Infect (Larchmt)", "year": 2018, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus disease (a cyst/infection near the tailbone)", "intervention": "laser hair removal (depilation)", "comparator": "non-laser treatment (in some included studies)", "primaryOutcome": "rate of disease recurrence", "result": "recurrence after laser treatment ranged from 0% to 28%, and 4 of 5 comparative studies showed lower recurrence with laser than without", "resultDirection": "benefit", "quality": "low", "qualityWhy": "mostly retrospective, small, and widely varying studies make it hard to trust the pooled result.", "directness": "direct", "limitations": "Abstract states the literature is heterogeneous, mostly retrospective, with limited generalizability, and study sizes ranged from 1 to 86 patients.", "followUp": "6 months to 5 years", "plainFinding": "Fewer recurrences with laser hair removal.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30095368/", "sourceText": "BACKGROUND: Laser hair depilation has shown promise in small series of patients with pilonidal sinus disease. The purpose of this study was to review the published literature on laser hair depilation in pilonidal disease to determine its effect on disease recurrence. METHODS: The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched to identify all studies published through December 1, 2017 that examined the role of laser hair depilation in the treatment of pilonidal sinus disease. Study characteristics, including design, treatment regimen, number of patients evaluated, rate of recurrence, and duration of follow up were recorded. RESULTS: Thirty-five published studies were included. Of these, 28 studies were retrospective and seven were prospective. There were five comparative studies: two retrospective, one prospective observational, and two randomized controlled trials. The number of patients included in each study ranged from one to 86 patients and patients received between one and 11 laser treatments. The pilonidal disease recurrence rate after laser depilation ranged from 0% to 28% at a mean follow-up ranging from 6 months to 5 years across studies. Four of the five studies that included a comparative group demonstrated a decreased recurrence rate compared to the non-laser cohort. CONCLUSION: Laser hair depilation is a promising therapy in the management of pilonidal disease. However, the literature published to date is heterogeneous and has limited generalizability. Additional research is needed to determine the effectiveness of laser hair depilation to prevent pilonidal disease recurrence.", "provenance": [ { "field": "population", "quote": "patients with pilonidal sinus disease" }, { "field": "intervention", "quote": "Laser hair depilation" }, { "field": "comparator", "quote": "Four of the five studies that included a comparative group demonstrated a decreased recurrence rate compared to the non-laser cohort." }, { "field": "primaryOutcome", "quote": "rate of recurrence" }, { "field": "result", "quote": "The pilonidal disease recurrence rate after laser depilation ranged from 0% to 28% at a mean follow-up ranging from 6 months to 5 years across studies." }, { "field": "result", "quote": "Four of the five studies that included a comparative group demonstrated a decreased recurrence rate compared to the non-laser cohort." }, { "field": "followUp", "quote": "mean follow-up ranging from 6 months to 5 years" }, { "field": "limitations", "quote": "the literature published to date is heterogeneous and has limited generalizability" } ] }, { "id": "pmid:29878584", "pmid": "29878584", "doi": "10.1111/codi.14285", "nctId": null, "pmcid": null, "title": "A new minimally invasive treatment of pilonidal sinus disease with the use of a diode laser: a prospective large series of patients", "firstAuthor": "Pappas", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2018, "design": "prospective-cohort", "n": 237, "nField": "reported", "population": "patients with pilonidal sinus disease", "intervention": "minimally invasive diode laser treatment (SiLaT) of sinus tracts", "comparator": "none (single-arm study, compared informally to published literature)", "primaryOutcome": "healing rate and healing time after laser treatment", "result": "90.3% healed after first laser session, median healing time 47 days, low complication rate", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a single-group study without a comparison group, so it can't prove the laser is better than other treatments.", "directness": "direct", "limitations": "No control group; single-centre; relies on comparison to past published results rather than direct comparison.", "followUp": "", "plainFinding": "High healing rate with laser.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29878584/", "sourceText": "AIM: Various surgical techniques are available for the management of pilonidal sinus, but there is still controversy concerning the optimal surgical approach. The aim of our study was to evaluate the safety, efficacy and clinical outcome of a laser procedure for the treatment of pilonidal sinus. METHOD: Patients suffering from pilonidal sinus were operated on with sinus laser therapy (SiLaT) in our institute. SiLaT was applied under local anaesthesia after a small skin incision of 0.5-1 cm and careful cleaning of the sinus tracts with a curette. A radial fibre connected to a diode laser set at a wavelength of 1470 nm was then introduced into the tracts. The laser energy was delivered in continuous mode. RESULTS: Two-hundred and thirty-seven patients (183 male, median age 24 years, range 14-58) suffering from pilonidal sinus were operated on using the SiLaT laser procedure in our referral Institute and prospectively evaluated. A high healing rate was observed after the first session (90.3%, 214 of 237) with a median healing time of 47 days (range 30-70 days). A second treatment was offered for patients failing in the first session; this was successful in 78.3% (18/23). The duration of the procedure ranged between 20 and 30 min and had limited morbidity (wound infection in 7.2%, 17 of 237). CONCLUSION: SiLaT proved to be a safe and effective procedure for treating patients suffering from pilonidal sinus. Clinical results showed low morbidity and recurrence rates comparable to the published literature for other modern techniques.", "provenance": [ { "field": "n", "quote": "Two-hundred and thirty-seven patients (183 male, median age 24 years, range 14-58)" }, { "field": "population", "quote": "Patients suffering from pilonidal sinus" }, { "field": "intervention", "quote": "SiLaT was applied under local anaesthesia after a small skin incision of 0.5-1 cm and careful cleaning of the sinus tracts with a curette." }, { "field": "comparator", "quote": "Clinical results showed low morbidity and recurrence rates comparable to the published literature for other modern techniques." }, { "field": "primaryOutcome", "quote": "evaluate the safety, efficacy and clinical outcome of a laser procedure for the treatment of pilonidal sinus" }, { "field": "result", "quote": "A high healing rate was observed after the first session (90.3%, 214 of 237) with a median healing time of 47 days (range 30-70 days)." } ] }, { "id": "pmid:29633368", "pmid": "29633368", "doi": "10.1111/jdv.14991", "nctId": null, "pmcid": null, "title": "Laser hair removal after surgery vs. surgery alone for the treatment of pilonidal cysts: a retrospective case-control study", "firstAuthor": "Kelati", "multipleAuthors": true, "journal": "J Eur Acad Dermatol Venereol", "year": 2018, "design": "case-control", "n": 41, "nField": "reported", "population": "patients who had surgery for pilonidal cysts", "intervention": "laser hair removal after surgery", "comparator": "surgery alone", "primaryOutcome": "rate of pilonidal cyst recurrence after surgery", "result": "recurrence rate was much lower with laser hair removal (8.3%) than surgery alone (51.7%)", "resultDirection": "benefit", "quality": "low", "qualityWhy": "Small retrospective case-control study with only 12 patients in the treatment group and uneven follow-up times between groups.", "directness": "direct", "limitations": "Retrospective, small sample size, unequal follow-up durations between groups (18 vs 30 months median), single center.", "followUp": "18 months (1-30 months) for LHR group and 30 months (6-72 months) for surgery alone group", "plainFinding": "Fewer recurrences with laser hair removal.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29633368/", "sourceText": "BACKGROUND: Based on the presumed role of hair in pilonidal cyst (PNC) pathogenesis, laser epilation has been used to decrease recurrences. However, most of the data rely on case reports and uncontrolled series, and the rare controlled studies reported conflicting results. The objective of this study was to investigate the efficacy of laser hair removal (LHR) to decrease the recurrence rate after surgery of PNC vs. surgery alone. METHODS: We conducted a retrospective monocentric case-control study in the departments of Pediatric Surgery and Laser Center of Dermatology of the University Hospital of Nice in France from January 2010 to June 2017. We included all patients with PNC who had surgery during the period, and we compared patients who had LHR after surgery to those having surgery alone. The main outcome was the prevalence and number of recurrences of PNC in each group. RESULTS: Twelve patients - eight treated with alexandrite laser and four patients with Nd : YAG - were included in the cases group; 29 patients treated with surgery alone were included in the control group. The mean and the median number of laser sessions were 4.2 and 5, respectively (extremes 1-10). The postsurgical recurrence rate without LHR was 51.7%, and their number varied from 1 to 3. A significant decrease in the recurrence rate was observed after LHR (8.3%) compared to control group (P < 0.001). The median duration before recurrence was 14 months for surgery alone. The median follow-up was 18 months (1-30 months) for LHR group and 30 months (6-72 months) for surgery alone group. Two patients had abnormal healing or persistent sinus after surgery alone compared to none in the group who undergone laser procedure after surgery. CONCLUSIONS: Laser hair removal decreases the risk of delayed healing and of recurrences of PNL after surgical procedure.", "provenance": [ { "field": "n", "quote": "Twelve patients - eight treated with alexandrite laser and four patients with Nd : YAG - were included in the cases group; 29 patients treated with surgery alone were included in the control group." }, { "field": "population", "quote": "We included all patients with PNC who had surgery during the period" }, { "field": "intervention", "quote": "patients who had LHR after surgery" }, { "field": "comparator", "quote": "those having surgery alone" }, { "field": "primaryOutcome", "quote": "The main outcome was the prevalence and number of recurrences of PNC in each group." }, { "field": "result", "quote": "A significant decrease in the recurrence rate was observed after LHR (8.3%) compared to control group (P < 0.001)." }, { "field": "followUp", "quote": "The median follow-up was 18 months (1-30 months) for LHR group and 30 months (6-72 months) for surgery alone group." } ] }, { "id": "pmid:29217319", "pmid": "29217319", "doi": "10.1016/j.jpedsurg.2017.11.031", "nctId": null, "pmcid": null, "title": "Long-term analysis of surgical treatment outcomes in chronic pilonidal sinus disease", "firstAuthor": "Mutus", "multipleAuthors": true, "journal": "J Pediatr Surg", "year": 2018, "design": "case-series", "n": 268, "nField": "reported", "population": "adolescents who had surgery for chronic pilonidal sinus disease", "intervention": "laser hair removal (epilation) used after surgery in some patients", "comparator": "patients who did not have laser hair removal after surgery", "primaryOutcome": "recurrence of pilonidal sinus disease", "result": "none of the patients who had laser hair removal had a recurrence, while recurrences occurred in some patients overall", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this was a retrospective case series with no comparison group and only a small subgroup had laser hair removal, so it can't reliably show whether laser helped.", "directness": "indirect", "limitations": "retrospective design, no comparison group, small subgroup receiving laser epilation, recurrence also linked to poor hygiene rather than laser use alone", "followUp": "6-63 (median 25) months", "plainFinding": "No recurrences with laser hair removal.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29217319/", "sourceText": "BACKGROUND/PURPOSE: Chronic pilonidal sinus disease (PSD) is relatively common in adolescents and can be treated by various surgical techniques. This study aimed to evaluate the outcome in adolescents surgically treated for PSD in a single clinic. METHODS: PSD patients surgically treated over an 8-year period were retrospectively evaluated. Classical midline incision and excision with primary repair was performed in all. Regular follow up visits were scheduled. Evaluation of postoperative outpatient clinic records as well as telephone interviews for patients who were operated more than 6months ago were done for the long-term results, including coherence to regional hair care. RESULTS: There were 268 patients with a median age of 16years; 146 (54%) were males, and 122 (46%) were females. Outpatient follow up records were available for 249 (92.9%) patients with a median of postoperative 3months (7days-49months). Moreover, 114 (42.5% of total) patients were interviewed by telephone 6-63 (median 25) months after the surgery. In 36 (13.4%) patients, wound infection or dehiscence occurred within the first month of surgery and was treated by secondary healing. Recurrences were observed in 21 (7.8%) patients all having poor local hygiene. Laser epilation was employed in 32 (28%) patients, and none of these had recurrences. CONCLUSIONS: Classical midline incision and primary closure approach for surgical treatment of PSD in adolescents has similar results to adults. Postoperative hair removal seems to reduce recurrences. TYPE OF STUDY: Treatment study. LEVEL OF EVIDENCE: Level IV (Retrospective case series with no comparison group).", "provenance": [ { "field": "n", "quote": "There were 268 patients with a median age of 16years" }, { "field": "population", "quote": "PSD patients surgically treated over an 8-year period were retrospectively evaluated" }, { "field": "intervention", "quote": "Laser epilation was employed in 32 (28%) patients" }, { "field": "comparator", "quote": "Recurrences were observed in 21 (7.8%) patients all having poor local hygiene." }, { "field": "primaryOutcome", "quote": "Recurrences were observed in 21 (7.8%) patients" }, { "field": "result", "quote": "Laser epilation was employed in 32 (28%) patients, and none of these had recurrences." }, { "field": "followUp", "quote": "6-63 (median 25) months after the surgery" } ] }, { "id": "pmid:29185064", "pmid": "29185064", "doi": "10.1007/s10151-017-1722-9", "nctId": null, "pmcid": null, "title": "The effect of hair removal after surgery for sacrococcygeal pilonidal sinus disease: a systematic review of the literature", "firstAuthor": "Pronk", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2018, "design": "systematic-review", "n": 963, "nField": "reported", "population": "patients who had surgery for pilonidal sinus disease near the tailbone", "intervention": "laser hair removal after surgery", "comparator": "razor shaving/cream depilation or no hair removal after surgery", "primaryOutcome": "recurrence of pilonidal sinus disease", "result": "recurrence was lower with laser hair removal (9.3%) than razor/cream depilation (23.4%) or no hair removal (19.7%)", "resultDirection": "benefit", "quality": "low", "qualityWhy": "the included studies were mostly small, retrospective, and of limited methodological quality, so the comparison is not reliable.", "directness": "direct", "limitations": "small sample size and limited methodological quality of the included studies", "followUp": "37.0 (standard error of the mean: 35.0) months", "plainFinding": "Fewer recurrences with laser hair removal.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29185064/", "sourceText": "BACKGROUND: It has been suggested that removal of body hair in the sacrococcygeal area prevents recurrence after surgery for sacrococcygeal pilonidal sinus disease (SPSD). The aim of this study was to review the literature regarding the effect of hair depilation on the recurrence rate in patients surgically treated for SPSD. METHODS: A systematic search was performed in PubMed, EMBASE, and The Cochrane Library by using synonyms for SPSD. Title, abstract, and full text were screened by two independent reviewers. Data were systematically collected from all included studies by using a standardized data extraction form. RESULTS: The search and selection yielded 14 studies, involving 963 patients. The study design of the included studies was: retrospective cohort (n = 7), prospective cohort (n = 3), randomized controlled trial (n = 2), and case-control (n = 2).The mean length of follow-up was 37.0 (standard error of the mean: 35.0) months. The recurrence rate was 9.3% (34 out of 366 patients) in patients who had laser hair removal, 23.4% (36 out of 154 patients) in those who had razor shaving/cream depilation, and 19.7% (85 out of 431 patients) in those who had no hair removal after surgery for SPSD. CONCLUSIONS: This systematic review showed a lower recurrence rate after laser hair removal compared to no hair removal and razor/cream depilation. Due to the small sample size and limited methodological quality of the included studies, a high-quality randomized controlled trial is required.", "provenance": [ { "field": "n", "quote": "involving 963 patients" }, { "field": "population", "quote": "patients surgically treated for SPSD" }, { "field": "intervention", "quote": "laser hair removal" }, { "field": "comparator", "quote": "razor shaving/cream depilation" }, { "field": "comparator", "quote": "no hair removal after surgery for SPSD" }, { "field": "primaryOutcome", "quote": "the effect of hair depilation on the recurrence rate" }, { "field": "result", "quote": "The recurrence rate was 9.3% (34 out of 366 patients) in patients who had laser hair removal, 23.4% (36 out of 154 patients) in those who had razor shaving/cream depilation, and 19.7% (85 out of 431 patients) in those who had no hair removal after surgery for SPSD." }, { "field": "followUp", "quote": "The mean length of follow-up was 37.0 (standard error of the mean: 35.0) months." }, { "field": "limitations", "quote": "Due to the small sample size and limited methodological quality of the included studies, a high-quality randomized controlled trial is required." } ] }, { "id": "pmid:29016243", "pmid": "29016243", "doi": "10.1089/sur.2017.153", "nctId": null, "pmcid": null, "title": "Safety and Tolerability of Laser Hair Depilation in Pilonidal Disease: A Pilot Study", "firstAuthor": "Lopez", "multipleAuthors": true, "journal": "Surg Infect (Larchmt)", "year": 2017, "design": "case-series", "n": 13, "nField": "reported", "population": "adolescents with pilonidal disease", "intervention": "laser hair removal of the natal cleft, every 4 weeks for up to 5 sessions", "comparator": "none (single-arm study)", "primaryOutcome": "tolerability and safety of laser treatment (pain scores and burns)", "result": "all treatments well tolerated with no burns, and all patients remained recurrence-free at follow-up", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "Very small single-arm pilot study with no comparison group, so it cannot prove the laser itself prevents recurrence.", "directness": "direct", "limitations": "Single-arm pilot study with only 13 patients, no control group, and short follow-up.", "followUp": "median follow-up of 13 months", "plainFinding": "Safe, well tolerated, no recurrences seen.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29016243/", "sourceText": "BACKGROUND: Pilonidal disease is a common and painful disorder that can be challenging to manage. Recurrent surgical treatment is often warranted and may result in significant morbidity, with reported wound complication rates as high as 30%. Laser hair depilation of the natal cleft may decrease the incidence of recurrence. The purpose of this study was to assess the safety and tolerability of laser hair depilation in adolescents with pilonidal disease. METHODS: We performed a prospective, single arm, pilot trial of laser hair depilation to the natal cleft in 13 patients with pilonidal disease. Each patient received an outpatient laser depilation treatment every four weeks with a goal of five total treatments. Follow-up tolerability was measured after each treatment by obtaining Likert scale, patient-reported, pain scores immediately after laser treatment and every six hours post-treatment, for the first 24 hours. Consistent pain scores <4 were used as a proxy for tolerability. The primary end point was tolerability and safety, defined as pain scores consistently <4 and no deep second-degree burns during the 24-hour post-treatment period. The secondary end point was disease recurrence at one year. RESULTS: Thirteen patients were enrolled with 12 patients completing five laser depilation treatment sessions and one patient completing only four. There was 100% tolerability of treatments with no occurrence of second-degree burns. No patient was unable to complete a treatment session because of discomfort. Significantly diminished hair growth was noted after three treatments. All 13 patients were recurrence-free at a median follow-up of 13 months post-treatment initiation. CONCLUSIONS: Laser hair depilation is safe and well tolerated in adolescents with pilonidal disease and may be effective at decreasing pilonidal disease recurrence. A prospective randomized controlled trial is planned to determine effectiveness of laser hair depilation compared with chemical/mechanical depilation methods in preventing pilonidal disease recurrence.", "provenance": [ { "field": "population", "quote": "adolescents with pilonidal disease" }, { "field": "intervention", "quote": "laser hair depilation to the natal cleft in 13 patients with pilonidal disease" }, { "field": "comparator", "quote": "prospective, single arm, pilot trial" }, { "field": "primaryOutcome", "quote": "The primary end point was tolerability and safety, defined as pain scores consistently <4 and no deep second-degree burns during the 24-hour post-treatment period." }, { "field": "result", "quote": "There was 100% tolerability of treatments with no occurrence of second-degree burns." }, { "field": "result", "quote": "All 13 patients were recurrence-free at a median follow-up of 13 months post-treatment initiation." }, { "field": "n", "quote": "Thirteen patients were enrolled with 12 patients completing five laser depilation treatment sessions and one patient completing only four." }, { "field": "followUp", "quote": "median follow-up of 13 months" } ] }, { "id": "pmid:28521574", "pmid": "28521574", "doi": "10.1080/09546634.2017.1329513", "nctId": null, "pmcid": null, "title": "Treatment of recurrent pilonidal cysts with nd-YAG laser: report of our experience", "firstAuthor": "Dragoni", "multipleAuthors": true, "journal": "J Dermatolog Treat", "year": 2018, "design": "case-series", "n": 10, "nField": "reported", "population": "patients with recurrent pilonidal cysts", "intervention": "Nd-YAG laser hair removal treatment", "comparator": "no comparator (before-after ultrasound and symptom assessment)", "primaryOutcome": "symptom resolution and disappearance of cyst on ultrasound", "result": "all patients became symptom-free and cysts disappeared on ultrasound, with no recurrence during follow-up", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This was a tiny uncontrolled study of only 10 patients with no comparison group, so it cannot reliably show the laser works better than other options.", "directness": "direct", "limitations": "Very small sample size, no control group, abstract does not report length of follow-up period or blinding.", "followUp": "", "plainFinding": "Cysts resolved, no recurrence seen.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/28521574/", "sourceText": "PURPOSE: Surgical treatment remains the first-line therapy of pilonidal cyst but is associated with high levels of postoperative pain, adverse events and a recurrence rate of 30%. We report our experience with laser hair removal using the Nd-YAG laser for the treatment of pilonidal cyst. MATERIALS AND METHODS: Ten patients affected by pilonidal cyst were examined and treated from October 2011 to November 2016. Treatments were carried out using the Nd-YAG laser (Deka M.E.L.A, Calenzano, Florence, Italy) at a wavelength of 1064 nm at 30-day interval. RESULTS: Nine patients were asymptomatic after the second treatment, while in one case the symptom disappeared after the fourth session. After 4-8 treatments, the pilonidal cyst had clinically disappeared and patients subjectively felt healed. In all cases, the soft-tissue ultrasounds performed before the first and after the last session showed the disappearance of the pilonidal cyst. In the follow-up, all the patients remained asymptomatic without any disease recurrence. CONCLUSIONS: Nd-YAG laser is an effective treatment for pilonidal cysts, providing excellent results with quick healing and no risk of serious adverse side-effects. It could be a very attractive alternative to open surgery, enabling patients to prevent the frequent and severe postoperative issues associated with surgery.", "provenance": [ { "field": "population", "quote": "Ten patients affected by pilonidal cyst were examined and treated" }, { "field": "intervention", "quote": "laser hair removal using the Nd-YAG laser for the treatment of pilonidal cyst" }, { "field": "comparator", "quote": "soft-tissue ultrasounds performed before the first and after the last session" }, { "field": "primaryOutcome", "quote": "Nine patients were asymptomatic after the second treatment" }, { "field": "result", "quote": "In the follow-up, all the patients remained asymptomatic without any disease recurrence." }, { "field": "n", "quote": "Ten patients affected by pilonidal cyst were examined and treated" } ] }, { "id": "pmid:28056720", "pmid": "28056720", "doi": "10.1080/00015458.2016.1272285", "nctId": null, "pmcid": null, "title": "Pilonidal sinus destruction with a radial laser probe: technique and first Belgian experience", "firstAuthor": "Dessily", "multipleAuthors": true, "journal": "Acta Chir Belg", "year": 2017, "design": "retrospective", "n": 40, "nField": "reported", "population": "adults with pilonidal sinus disease", "intervention": "laser destruction of the pilonidal cyst using a radial laser probe (FILAC)", "comparator": "none (single-arm case series)", "primaryOutcome": "treatment success (healing) rate", "result": "87.5% success rate with a 2.9% recurrence rate", "resultDirection": "benefit", "quality": "low", "qualityWhy": "Small, retrospective, single-arm case series without a comparison group, so it cannot show if laser works better than other treatments.", "directness": "direct", "limitations": "Retrospective design, no control group, small sample size of 40 patients.", "followUp": "234 days (92-316)", "plainFinding": "High success, few complications.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/28056720/", "sourceText": "BACKGROUND: The treatment of pilonidal sinus disease still remains challenging. Despite many non-surgical and surgical methods, no consensus emerged for the best treatment. We describe a new innovative technique consisting in the destruction of the pilonidal cyst with a radial laser probe (FILACTM, Biolitec, Germany). The energy delivered causes the destruction of the sinus epithelium and the simultaneous obliteration of the tract. METHOD: In December 2015, we retrospectively studied the data of our 40 first patients operated with this technique between September 2014 and September 2015. The mean follow-up period was 234 days (92-316). There were 33 men and 7 women. The mean age of the patients was 25.2 years (15-46). RESULTS: The success rate was 87.5% (35 patients/40). Recurrence rate was 2.9% (1 patient/35). Hospital stay was 1 day for all the patients with no re-hospitalisation during the follow-up. The mean duration of soiling before healing was 18.6 days (2-35). The mean duration of pain-killers intake was 4.9 days (0-14). Four patients presented complications: 2 hematomas (5%) and 2 abscesses (5%), all medically treated. CONCLUSION: The destruction of a pilonidal cyst with a laser probe is a safe, simple and minimally invasive technique. The success rate is good. Hospital stay is short, pain is light and complications are few as well as the number of patients needing post-operative care, allowing a rapid return to work or school. This technique could be proposed as a first-line treatment to the majority of patients with a pilonidal sinus disease.", "provenance": [ { "field": "n", "quote": "we retrospectively studied the data of our 40 first patients" }, { "field": "population", "quote": "patients operated with this technique" }, { "field": "intervention", "quote": "destruction of the pilonidal cyst with a radial laser probe (FILACTM, Biolitec, Germany)" }, { "field": "comparator", "quote": "Despite many non-surgical and surgical methods, no consensus emerged for the best treatment." }, { "field": "primaryOutcome", "quote": "The success rate was 87.5% (35 patients/40)." }, { "field": "result", "quote": "The success rate was 87.5% (35 patients/40). Recurrence rate was 2.9% (1 patient/35)." }, { "field": "followUp", "quote": "The mean follow-up period was 234 days (92-316)." } ] }, { "id": "pmid:27003897", "pmid": "27003897", "doi": "10.1007/s10103-016-1920-0", "nctId": null, "pmcid": null, "title": "Control of hair growth using long-pulsed alexandrite laser is an efficient and cost effective therapy for patients suffering from recurrent pilonidal disease", "firstAuthor": "Khan", "multipleAuthors": true, "journal": "Lasers Med Sci", "year": 2016, "design": "retrospective", "n": 19, "nField": "reported", "population": "patients with recurrent pilonidal sinus after multiple surgeries", "intervention": "laser hair removal (long-pulsed alexandrite laser) in the sinus area", "comparator": "previous surgical treatment", "primaryOutcome": "time without disease recurrence and cost per disease-free month", "result": "laser treatment led to longer disease-free periods and lower cost than repeat surgery", "resultDirection": "benefit", "quality": "low", "qualityWhy": "small retrospective study without randomization or control group comparison at the same time.", "directness": "direct", "limitations": "retrospective design, small sample size, comparison to historical surgical outcomes rather than a concurrent control group", "followUp": "", "plainFinding": "", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/27003897/", "sourceText": "Pilonidal sinus (PNS) and its surgical management have a profound impact on hospital resources in terms of finances and productive man-hours. Surgical treatment has been the mainstay of treatment of both acute and chronic pilonidal sinus but recurrence is common. The control of hair growth in the sinus region plays an important role in preventing recurrence. Here, we discuss our experience of treating 19 patients suffering from recurrent pilonidal sinus with laser depilation and its long-term cost effectiveness. This is a retrospective study on patients who had recurrence of pilonidal sinus following multiple surgical treatments. They were treated using long-pulsed alexandrite laser for depilation in the sinus area, an outpatient procedure. Their clinical characteristics and outcomes were then evaluated. There was a significant reduction in hair density after laser treatment (p < 0.001). The disease-free period after laser treatment was significantly longer than that one after surgical treatment (p < 0.001). The average cost of repeated surgical treatment per disease-free month was significantly higher than that of laser treatment (p < 0.001). Evidence suggests the role of natal cleft hair growth in the evolution of the pilonidal disease; therefore, control of hair growth should be considered as an adjunct to the initial treatment via surgery. Compared to surgical treatment of recurrences, laser depilation is an efficient and cost-effective method of preventing recurrence and reducing morbidity and loss of man-hours. We suggest that laser depilation of the pilonidal sinus should be funded by clinical commissioning groups.", "provenance": [ { "field": "n", "quote": "treating 19 patients suffering from recurrent pilonidal sinus with laser depilation" }, { "field": "population", "quote": "patients who had recurrence of pilonidal sinus following multiple surgical treatments" }, { "field": "intervention", "quote": "treated using long-pulsed alexandrite laser for depilation in the sinus area" }, { "field": "comparator", "quote": "The disease-free period after laser treatment was significantly longer than that one after surgical treatment" }, { "field": "primaryOutcome", "quote": "The disease-free period after laser treatment was significantly longer than that one after surgical treatment (p < 0.001)." }, { "field": "result", "quote": "laser depilation is an efficient and cost-effective method of preventing recurrence and reducing morbidity and loss of man-hours" } ] }, { "id": "pmid:26690708", "pmid": "26690708", "doi": "10.1016/j.jpedsurg.2015.10.076", "nctId": null, "pmcid": null, "title": "Improving outcomes in pilonidal sinus disease", "firstAuthor": "Braungart", "multipleAuthors": true, "journal": "J Pediatr Surg", "year": 2016, "design": "retrospective", "n": 18, "nField": "reported", "population": "children and teenagers with previously infected pilonidal sinus disease", "intervention": "laser hair removal of the natal cleft after surgical excision", "comparator": "patients who did not have laser hair removal", "primaryOutcome": "recurrence of pilonidal sinus requiring further surgery", "result": "no further recurrence in patients who had laser hair removal, but authors call results preliminary", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "Very small retrospective subgroup (7 of 18 patients) with no formal comparison group, so the laser result could easily be due to chance.", "directness": "indirect", "limitations": "Single-center retrospective review, small numbers, laser hair removal was an add-on to surgery in a minority of patients, not a controlled comparison.", "followUp": "13months (3.5-67months)", "plainFinding": "Fewer recurrences, but very preliminary.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/26690708/", "sourceText": "BACKGROUND: Optimal surgical treatment for pilonidal sinus disease remains controversial. Studies in children are uncommon with overall high postoperative recurrence and infection rates (20%). Our unit adopted a technique for excision of the pilonidal sinus with primary midline closure using a full-thickness flap. We present our results of this technique in the pediatric age group. METHODS: Single-center retrospective review and telephone follow-up was performed, including all children undergoing pilonidal sinus excision from 2005 to 2014 using the same operative technique and preoperative/postoperative care. RESULTS: 19 children were identified. Median age was 15years, and 47% were male. All had previously infected sinuses, with 5 requiring abscess drainage. Median follow-up was 13months (3.5-67months). Histology confirmed pilonidal sinus in 18/19 cases (one developmental malformation excluded from subsequent analysis). Recurrence requiring further surgery occurred in 4/18 (22%) patients at a median of 9months (range 8-36), wound dehiscence in 8/18 (44%), and wound infection in 5/18 (28%) cases. Laser hair removal of the natal cleft was performed in 7/18 (39%) patients with no further recurrence. CONCLUSION: This is the first report of this technique in children which showed a higher incidence of complications than a comparable adult study. Our study underlines the importance of accurate long-term outcomes when introducing new techniques to evaluate operation-associated morbidity. Our preliminary results of laser hair removal are promising but need to be evaluated with a prospective study.", "provenance": [ { "field": "n", "quote": "Histology confirmed pilonidal sinus in 18/19 cases (one developmental malformation excluded from subsequent analysis)." }, { "field": "population", "quote": "All had previously infected sinuses, with 5 requiring abscess drainage." }, { "field": "intervention", "quote": "Laser hair removal of the natal cleft was performed in 7/18 (39%) patients with no further recurrence." }, { "field": "comparator", "quote": "Laser hair removal of the natal cleft was performed in 7/18 (39%) patients with no further recurrence." }, { "field": "primaryOutcome", "quote": "Recurrence requiring further surgery occurred in 4/18 (22%) patients at a median of 9months (range 8-36)" }, { "field": "result", "quote": "Our preliminary results of laser hair removal are promising but need to be evaluated with a prospective study." } ] }, { "id": "pmid:26377583", "pmid": "26377583", "doi": "10.1007/s10151-015-1369-3", "nctId": null, "pmcid": null, "title": "The treatment of pilonidal disease: guidelines of the Italian Society of Colorectal Surgery (SICCR)", "firstAuthor": "Segre", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2015, "design": "guideline", "n": null, "nField": "not-reported", "population": "people with pilonidal disease", "intervention": "laser epilation as part of nonoperative management", "comparator": "other nonoperative treatments such as gluteal cleft shaving, fibrin glue and phenol injection", "primaryOutcome": "healing rates and recurrence incidence", "result": "satisfactory healing and recurrence rates reported, but evidence quality is low", "resultDirection": "unclear", "quality": "low", "qualityWhy": "The guideline itself states that most supporting studies are small with low-quality evidence.", "directness": "indirect", "limitations": "Abstract notes studies are small series with low-quality evidence and does not give specific data for laser alone.", "followUp": "", "plainFinding": "Reported to help, but evidence weak", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/26377583/", "sourceText": "The Italian Society of Colorectal Surgery (SICCR.) has prepared clinical practice guidelines to help its members to optimize the treatment of pilonidal disease, a very common condition, especially among young people, and therefore of great importance on a socioeconomic level. The SICCR committee of experts on pilonidal disease analyzed the international literature and evaluated current evidence. Nonoperative management includes gluteal cleft shaving, laser epilation as well as fibrin glue and phenol injection: reported healing rates and recurrence incidence are satisfactory but the majority of studies are small series with low-quality evidence. Surgical therapy which can be divided into two categories: excision of diseased tissue with primary closure using different techniques or excision with healing by secondary intention. On the whole, no clear benefit is demonstrated for one technique over the other.", "provenance": [ { "field": "intervention", "quote": "laser epilation as well as fibrin glue and phenol injection" }, { "field": "comparator", "quote": "gluteal cleft shaving, laser epilation as well as fibrin glue and phenol injection" }, { "field": "primaryOutcome", "quote": "reported healing rates and recurrence incidence are satisfactory" }, { "field": "result", "quote": "reported healing rates and recurrence incidence are satisfactory but the majority of studies are small series with low-quality evidence" }, { "field": "population", "quote": "pilonidal disease, a very common condition, especially among young people" } ] }, { "id": "pmid:26011854", "pmid": "26011854", "doi": "10.1503/cjs.011214", "nctId": null, "pmcid": "PMC4447517", "title": "Hair epilation versus surgical excision as primary management of pilonidal disease in the pediatric population", "firstAuthor": "Bütter", "multipleAuthors": true, "journal": "Can J Surg", "year": 2015, "design": "retrospective", "n": null, "nField": "not-reported", "population": "children with pilonidal disease", "intervention": "laser hair epilation", "comparator": "surgical excision", "primaryOutcome": "recurrence rates and patient satisfaction", "result": "abstract only describes the study topic, no outcome data given", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "The abstract is retrospective and does not report any actual outcome numbers or statistics, only stating that recurrence and satisfaction will be discussed.", "directness": "direct", "limitations": "No quantitative results, recurrence rates, or satisfaction scores are given in this abstract.", "followUp": "", "plainFinding": "No outcome data given.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/26011854/", "sourceText": "Pilonidal disease is a chronic, acquired inflammatory process of the skin due to entrapped hair at the natal cleft. Reported recurrence rates are as high as 30%, and recurrence has been attributed to persistent hair near the surgical site. Although conservative measures, such as meticulous hair control and improved perineal hygiene, have been shown to be effective, these techniques typically require much effort on behalf of the patient. Laser hair epilation (LE) might solve this issue of poor patient compliance while helping patients to avoid surgical excision. In this article, we discuss recurrence rates of pilonidal disease in children treated with LE versus surgical excision in relation to findings from our institution between 2005 and 2013 as well as patient satisfaction with the treatment method.", "provenance": [ { "field": "population", "quote": "treated with LE versus surgical excision" }, { "field": "intervention", "quote": "Laser hair epilation (LE) might solve this issue of poor patient compliance" }, { "field": "comparator", "quote": "versus surgical excision in relation to findings from our institution" }, { "field": "primaryOutcome", "quote": "we discuss recurrence rates of pilonidal disease in children treated with LE versus surgical excision" }, { "field": "result", "quote": "we discuss recurrence rates of pilonidal disease in children treated with LE versus surgical excision in relation to findings from our institution between 2005 and 2013 as well as patient satisfaction with the treatment method." } ] }, { "id": "pmid:25932257", "pmid": "25932257", "doi": null, "nctId": null, "pmcid": "PMC4402904", "title": "The effect of laser epilation on recurrence and satisfaction in patients with sacrococcygeal pilonidal disease: a prospective randomized controlled trial", "firstAuthor": "Demircan", "multipleAuthors": true, "journal": "Int J Clin Exp Med", "year": 2015, "design": "rct", "n": 60, "nField": "reported", "population": "patients having surgery for pilonidal sinus disease", "intervention": "laser hair removal added to Karydakis flap surgery", "comparator": "Karydakis flap surgery alone", "primaryOutcome": "recurrence of pilonidal disease and patient satisfaction after surgery", "result": "recurrence was significantly higher in the laser group (20%) than the surgery-only group (4%) at one year, with satisfaction scores differing only in the first week and month", "resultDirection": "harm", "quality": "moderate", "qualityWhy": "it was a randomized trial but small, from a single clinic, with recurrence checked only by phone interview.", "directness": "direct", "limitations": "small sample of 30 per group, single-center study, recurrence assessed via telephone interview rather than in-person exam", "followUp": "1 year", "plainFinding": "More recurrence when laser added.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/25932257/", "sourceText": "BACKGROUND: The primary aim of this prospective study was to investigate the effects of laser epilation on patient satisfaction and recurrence in patients who underwent pilonidal sinus surgery. METHOD: Sixty patients scheduled for pilonidal sinus surgery in our clinic between 2011 and 2012 were enrolled in this prospective randomized controlled study. Patients were divided in two groups of 30 patients each. Only the Karydakis flap reconstruction technique was performed in the first group. Two sessions of laser epilation were applied in the second group in addition to Karydakis flap reconstruction. The patients in the second group underwent laser epilation 2 weeks before and 3 weeks after the surgery for a total of 2 times in a private office. RESULTS: There were no statistically significant differences between the groups in terms of age, gender, smoking usage, ASA Score, duration of patient's complaints, BMI and hospital stay. There were no statistically significant differences between the groups in terms of surgical site infection, wound separation, abscess formation at the any time postoperatively. There were statistically significant differences between the two groups in the first week post operation considering the VAS pain score (P<0.03) and VAS satisfaction score (P<0.01). While there were statistically significant differences between the two groups in the first month post operation considering the VAS pain score (P<0.0001), there were no statistically significant differences between the groups in terms of VAS satisfaction score in the first and three month postoperatively. In the telephone interviews done 1 year after the surgery, recurrence were detected in 4% of first group and in 20% of second group. Recurrence rates were significantly higher in the second group (P=0.045). CONCLUSION: Our results show that laser epilation does not reduce the relapse rates in pilonidal sinus surgery, as expected. It is obvious that prospective randomized studies need to be held on this subject.", "provenance": [ { "field": "n", "quote": "Sixty patients scheduled for pilonidal sinus surgery in our clinic between 2011 and 2012 were enrolled in this prospective randomized controlled study." }, { "field": "population", "quote": "patients who underwent pilonidal sinus surgery" }, { "field": "intervention", "quote": "Two sessions of laser epilation were applied in the second group in addition to Karydakis flap reconstruction." }, { "field": "comparator", "quote": "Only the Karydakis flap reconstruction technique was performed in the first group." }, { "field": "primaryOutcome", "quote": "investigate the effects of laser epilation on patient satisfaction and recurrence in patients who underwent pilonidal sinus surgery" }, { "field": "result", "quote": "recurrence were detected in 4% of first group and in 20% of second group. Recurrence rates were significantly higher in the second group (P=0.045)." } ] }, { "id": "pmid:24173910", "pmid": "24173910", "doi": "10.1007/s10103-013-1464-5", "nctId": null, "pmcid": null, "title": "The diverse application of laser hair removal therapy: a tertiary laser unit's experience with less common indications and a literature overview", "firstAuthor": "Koch", "multipleAuthors": true, "journal": "Lasers Med Sci", "year": 2015, "design": "case-series", "n": 31, "nField": "reported", "population": "patients treated with laser hair removal for various uncommon conditions, including some with pilonidal sinus disease", "intervention": "laser hair removal therapy", "comparator": "no comparator group", "primaryOutcome": "symptom and functional improvement with patient satisfaction", "result": "abstract states laser hair removal appeared effective for pilonidal sinus disease among other inflammatory conditions, especially early in disease, but no specific data for this subgroup are given", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a small retrospective case series mixing many different skin conditions with no comparison group, so it can't reliably show whether laser helped pilonidal cysts specifically.", "directness": "indirect", "limitations": "Retrospective review of case notes; small total number of patients across many different indications; no control group; no separate outcome data for pilonidal sinus disease patients.", "followUp": "", "plainFinding": "Reported to help pilonidal sinus disease.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/24173910/", "sourceText": "We describe the diversity of indications for laser hair removal (LHR) therapy and compare our experience with the literature. Patients' case notes referred to the Birmingham Regional Skin Laser Centre between 2003 and 2011 for laser hair removal, with indications other than hirsutism, were reviewed retrospectively. Thirty-one treated patients with the following indications were identified: hair-bearing skin grafts/flaps, intra-oral hair-bearing flap, Becker's naevus, localised nevoid hypertrichosis, peristomal hair-bearing skin, scrotal skin prior to vaginoplasty in male-to-female (MTF) gender reassignment, pilonidal sinus disease (PSD), pseudofolliculitis barbae (PFB) and hidradenitis suppurativa (HS). Seven patients with the following indications have been reported before: intra-oral hair-bearing graft, naevoid hypertrichosis and peristomal hair-bearing skin. A clinical review of the evidence available for each indication is provided. Our experience and that in the published literature suggest that LHR is a safe, well-tolerated and effective treatment modality for the indications we report, leading to significant symptom and functional improvement with high patient satisfaction. LHR appears effective in the treatment of chronic inflammatory conditions such as PSD, PFB and HS, particularly at an early disease stage. We aim to increase awareness of the diversity of laser hair removal indications and add evidence to the medical literature of the wide range of indications for this useful treatment modality.", "provenance": [ { "field": "n", "quote": "Thirty-one treated patients with the following indications were identified" }, { "field": "population", "quote": "pilonidal sinus disease (PSD)" }, { "field": "intervention", "quote": "laser hair removal (LHR) therapy" }, { "field": "comparator", "quote": "Patients' case notes referred to the Birmingham Regional Skin Laser Centre between 2003 and 2011 for laser hair removal, with indications other than hirsutism, were reviewed retrospectively." }, { "field": "primaryOutcome", "quote": "leading to significant symptom and functional improvement with high patient satisfaction" }, { "field": "result", "quote": "LHR appears effective in the treatment of chronic inflammatory conditions such as PSD, PFB and HS, particularly at an early disease stage." } ] }, { "id": "pmid:23905297", "pmid": "23905297", "doi": null, "nctId": null, "pmcid": null, "title": "Reducing the recurrence of pilonidal sinus disease", "firstAuthor": "Marza", "multipleAuthors": false, "journal": "Nurs Times", "year": 2013, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus disease (a painful disorder between the buttocks)", "intervention": "laser hair removal", "comparator": "no laser hair removal (standard care/surgery alone)", "primaryOutcome": "recurrence of pilonidal sinus disease", "result": "laser hair removal reduced the rate of recurrence", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a narrative review/case report with no study data, numbers, or methods reported, so it cannot reliably support the claim.", "directness": "indirect", "limitations": "No participant numbers, study design details, or data are given; it is a general review combined with case reports rather than a controlled study.", "followUp": "", "plainFinding": "Laser hair removal may cut recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/23905297/", "sourceText": "Pilonidal sinus disease is a painful disorder of the natal cleft between the buttocks. Primary treatment is by surgery but there is a high recurrence rate. Laser hair removal reduces the rate of recurrence by diminishing the number and thickness of hairs. It should be recommended along with personal hygiene measures for patients to reduce short-term and long-term recurrence of the condition.", "provenance": [ { "field": "population", "quote": "Pilonidal sinus disease is a painful disorder of the natal cleft between the buttocks." }, { "field": "intervention", "quote": "Laser hair removal reduces the rate of recurrence by diminishing the number and thickness of hairs." }, { "field": "comparator", "quote": "Primary treatment is by surgery but there is a high recurrence rate." }, { "field": "primaryOutcome", "quote": "reduces the rate of recurrence" }, { "field": "result", "quote": "Laser hair removal reduces the rate of recurrence by diminishing the number and thickness of hairs." } ] }, { "id": "pmid:23798021", "pmid": "23798021", "doi": "10.1024/0040-5930/a000423", "nctId": null, "pmcid": null, "title": "[Therapy of pilonidal sinus--is more always better]", "firstAuthor": "Steinemann", "multipleAuthors": false, "journal": "Ther Umsch", "year": 2013, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus disease (young men most commonly affected)", "intervention": "laser hair removal to prevent recurrence after surgery", "comparator": "", "primaryOutcome": "preventing recurrence of pilonidal sinus", "result": "not quantified; laser epilation mentioned only as an option to consider on individual decision", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a general review article that only briefly mentions laser hair removal without any data or study results on its effectiveness.", "directness": "indirect", "limitations": "Abstract provides no data, numbers, or comparative results specifically for laser treatment; it is a general narrative review of surgical therapy with one sentence on laser as an adjunct.", "followUp": "", "plainFinding": "No evidence given for laser.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/23798021/", "sourceText": "Nowadays the etiology of pilonidal sinus is explained as an acquired disease in form of ruptured hair follicles. It occurs most frequently in the proximal rima ani. Pilonidal disease is common in young men. Acute abscess formation and chronic discharge from the fistula represent indications for surgery. Surgical therapy has evolved from radical excision followed by months of open wound healing towards procedures causing less morbidity. In case of an acute abscess it is important to separate time-wise incision of the abscess in local anaesthesia from definitive excision of the fistula. Two surgical methods are compelling. First the minimal-invasive sinusectomy with sparse excision of the pori and the fistula preserving intact subcutaneous tissue. This procedure can be performed in local anaesthesia in an outpatient setting. The recurrence rate after 4 years is 7 %. Alternatively there is the possibility of a primary plastic wound closure by a rotation flap. Open wound healing can be avoided and the recurrence rate is as low as 3 %. To prevent recurrences a laser epilation has to be considered on individual decision.", "provenance": [ { "field": "population", "quote": "Pilonidal disease is common in young men." }, { "field": "intervention", "quote": "To prevent recurrences a laser epilation has to be considered on individual decision." }, { "field": "primaryOutcome", "quote": "The recurrence rate after 4 years is 7 %." }, { "field": "result", "quote": "To prevent recurrences a laser epilation has to be considered on individual decision." } ] }, { "id": "pmid:23294066", "pmid": "23294066", "doi": "10.9738/CC130.1", "nctId": null, "pmcid": "PMC3727265", "title": "Minimally invasive treatment of pilonidal disease: crystallized phenol and laser depilation", "firstAuthor": "Girgin", "multipleAuthors": true, "journal": "Int Surg", "year": 2012, "design": "retrospective", "n": 42, "nField": "reported", "population": "patients with pilonidal cyst disease, chronic or recurrent", "intervention": "crystallized phenol treatment combined with 755-nm alexandrite laser hair removal", "comparator": "none (single-arm study, compared to own historical hypothesis of improved outcome)", "primaryOutcome": "complete healing and recurrence of pilonidal disease", "result": "all patients eventually healed with repeated treatments, and none had the disease come back during follow-up", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This was a small, retrospective study with no comparison group, so it can't prove laser added any real benefit.", "directness": "direct", "limitations": "Retrospective design, no control group, some patients needed up to 8 treatments, small sample size", "followUp": "mean 24 months (range, 6-30 months)", "plainFinding": "No recurrence after combined treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/23294066/", "sourceText": "Pilonidal disease has been treated surgically and by various other methods for many years. The most important problem associated with such treatment is recurrence, but cosmetic outcome is another important issue that cannot be ignored. Today, crystallized phenol is recognized as a treatment option associated with good medical and cosmetic outcomes. We hypothesized that the addition of laser depilation to crystallized phenol treatment of pilonidal disease might increase the rate of success, and this study aimed to determine if the hypothesis was true. Patients who were treated with crystallized phenol and 755-nm alexandrite laser depilation were retrospectively analyzed. In total, 42 (31 male and 11 female) patients were treated with crystallized phenol and alexandrite laser depilation and were followed up between January 2009 and January 2012. In all, 38 patients (90.5%) had chronic disease and 4 (9.5%) had recurrent disease. Among the patients, 26 (61.9%) recovered following 1 crystallized phenol treatment, and the remaining patients had complete remission following repeated treatment. Some patients needed multiple treatments, even up to 8 times. None of the patients had a recurrence during a mean 24 months (range, 6-30 months) of follow-up. Whatever method of treatment is used for pilonidal disease, hair cleaning positively affects treatment outcome. The present results support the hypothesis that the addition of laser depilation (which provides more permanent and effective depilation than other methods) to crystallized phenol treatment (a non-radical, minimally invasive method associated with very good cosmetic results) can increase the effectiveness of the treatment and also reduce the recurrence rate of the disease.", "provenance": [ { "field": "n", "quote": "In total, 42 (31 male and 11 female) patients were treated with crystallized phenol and alexandrite laser depilation" }, { "field": "population", "quote": "38 patients (90.5%) had chronic disease and 4 (9.5%) had recurrent disease" }, { "field": "intervention", "quote": "treated with crystallized phenol and 755-nm alexandrite laser depilation" }, { "field": "comparator", "quote": "Patients who were treated with crystallized phenol and 755-nm alexandrite laser depilation were retrospectively analyzed." }, { "field": "primaryOutcome", "quote": "None of the patients had a recurrence during a mean 24 months" }, { "field": "result", "quote": "None of the patients had a recurrence during a mean 24 months (range, 6-30 months) of follow-up." } ] }, { "id": "pmid:23112515", "pmid": "23112515", "doi": "10.4103/0974-2077.101377", "nctId": null, "pmcid": "PMC3483576", "title": "Use of lasers for the management of refractory cases of hidradenitis suppurativa and pilonidal sinus", "firstAuthor": "Jain", "multipleAuthors": true, "journal": "J Cutan Aesthet Surg", "year": 2012, "design": "case-series", "n": 9, "nField": "reported", "population": "patients with hidradenitis suppurativa and pilonidal sinus, refractory to treatment", "intervention": "combined CO2 laser deroofing and long pulse Nd:YAG laser hair follicle removal", "comparator": "none", "primaryOutcome": "recurrence of disease", "result": "no recurrence in any patient over follow-up", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "Very small uncontrolled case series with only 5 pilonidal sinus patients, so little confidence can be placed in the result.", "directness": "indirect", "limitations": "small sample size, no control group, mixed conditions (HS and PNS) reported together", "followUp": "3 years", "plainFinding": "No recurrence after laser treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/23112515/", "sourceText": "BACKGROUND: Hidradinitis suppurativa (HS) and pilonidal sinus (PNS) are chronic inflamatory skin diseases, often refractory to treatment and search for a new treatment is on. We tried deroofing with the help of carbon dioxide laser in patients of HS and PNS, however there was recurrence. AIM: To evaluate a technique combining the use of CO(2) laser and long pulse 1064 nm Neodymium-doped Yttrium Aluminium Garnet (Nd:YAG) laser for the treatment of HS and PNS. MATERIALS AND METHODS: In 4 patients with HS and 5 patients with PNS, we performed procedure in two steps: first destroying the hair follicles with long pulse Nd yag 1064 laserfollowed by deroofing with carbon di oxide laser. Follow up was done upto 3 years. RESULTS: All patients with HS were females in the age group of 30-40 years. In PNS, 2 male patients were of age less than 20, two male patients of age more than 20 and one females of age less than 20. None of the HS or PNS patients showed recurrence. CONCLUSION: The deroofing with CO(2) laser along with hair follicle removal with long pulse Nd:YAG laser is an effective minimally invasive tissue saving surgical intervention for the treatment of refractory HS and PNS lesions.", "provenance": [ { "field": "n", "quote": "In 4 patients with HS and 5 patients with PNS" }, { "field": "population", "quote": "Hidradinitis suppurativa (HS) and pilonidal sinus (PNS) are chronic inflamatory skin diseases, often refractory to treatment" }, { "field": "intervention", "quote": "a technique combining the use of CO(2) laser and long pulse 1064 nm Neodymium-doped Yttrium Aluminium Garnet (Nd:YAG) laser" }, { "field": "comparator", "quote": "we performed procedure in two steps: first destroying the hair follicles with long pulse Nd yag 1064 laserfollowed by deroofing with carbon di oxide laser" }, { "field": "primaryOutcome", "quote": "None of the HS or PNS patients showed recurrence." }, { "field": "result", "quote": "None of the HS or PNS patients showed recurrence." } ] }, { "id": "pmid:22279385", "pmid": "22279385", "doi": "10.4103/0974-2077.91251", "nctId": null, "pmcid": "PMC3263130", "title": "Laser hair removal as adjunct to surgery for pilonidal sinus: our initial experience", "firstAuthor": "Ghnnam", "multipleAuthors": true, "journal": "J Cutan Aesthet Surg", "year": 2011, "design": "rct", "n": null, "nField": "not-reported", "population": "people who had surgery for pilonidal sinus disease", "intervention": "permanent laser hair removal after surgery", "comparator": "conventional hair removal methods (razor, depilatory creams)", "primaryOutcome": "recurrence of pilonidal disease", "result": "Laser group had no recurrences and reported the procedure comfortable with no complications, while the conventional-method group had two recurrences linked to difficulty maintaining hair removal", "resultDirection": "benefit", "quality": "low", "qualityWhy": "The study is small, does not report overall patient numbers, and the authors themselves say larger studies with longer follow-up are needed.", "directness": "direct", "limitations": "Total number of participants not reported; authors state larger studies with long-term follow-up are still needed to confirm the conclusion.", "followUp": "", "plainFinding": "Fewer recurrences with laser hair removal.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/22279385/", "sourceText": "BACKGROUND: Chronic pilonidal disease is a common debilitating condition. It is a cause of considerable morbidity and social embarrassment. This prospective randomized study compared permanent laser hair removal following the excision of pilonidal disease with conventional methods for hair removal. MATERIALS AND METHODS: PATIENTS UNDERGOING SURGERY FOR PILONIDAL DISEASE WERE RANDOMIZED TO TWO GROUPS: those using laser hair removal methods following completed healing of wounds (group I) or regular post-healing conventional methods for hair removal, mainly razor and depilatory creams, for at least 6 months (group II). Group I patients received regular, monthly laser hair treatment sessions using Alexandrite laser for four sessions. RESULTS: Group I patients had a mean age of 23.6 ± 4.7 years. Group I patients had monthly laser hair removal session and then they were regularly followed up within the proposed schedule. They found the procedure comfortable with no complications. Group II patients had a mean age of 23.7 ± 6.6 years; they reported difficulty in maintaining hair removal with these conventional methods, and mostly, by the end of the first year, all cases stopped maintaining regular hair removal. Recurrence occurred in Group II patients (two cases) mostly due to failure in maintaining hair removal and area hygiene. CONCLUSIONS: We advocate the use of laser epilation after surgery for pilonidal sinus as it decreases the chance of recurrence but larger studies with long-term follow-up are still needed to approve this conclusion.", "provenance": [ { "field": "result", "quote": "They found the procedure comfortable with no complications." }, { "field": "result", "quote": "Recurrence occurred in Group II patients (two cases) mostly due to failure in maintaining hair removal and area hygiene." }, { "field": "primaryOutcome", "quote": "as it decreases the chance of recurrence" }, { "field": "intervention", "quote": "those using laser hair removal methods following completed healing of wounds (group I)" }, { "field": "comparator", "quote": "regular post-healing conventional methods for hair removal, mainly razor and depilatory creams, for at least 6 months (group II)" }, { "field": "population", "quote": "PATIENTS UNDERGOING SURGERY FOR PILONIDAL DISEASE WERE RANDOMIZED TO TWO GROUPS" } ] }, { "id": "pmid:21927795", "pmid": "21927795", "doi": "10.1007/s10103-011-0990-2", "nctId": null, "pmcid": null, "title": "Nd-YAG laser treatment of primary and recurrent pilonidal sinus", "firstAuthor": "Lindholt-Jensen", "multipleAuthors": true, "journal": "Lasers Med Sci", "year": 2012, "design": "case-series", "n": 41, "nField": "reported", "population": "patients with pilonidal sinus (primary and recurrent)", "intervention": "Nd-YAG laser treatment of the sinus tract", "comparator": "none (no control group)", "primaryOutcome": "freedom from symptoms at follow-up", "result": "75.7% symptom-free without extra treatment; 81% symptom-free with additional laser or minor surgery", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a small uncontrolled case series with no comparison group, so it can't show if laser works better than other options.", "directness": "direct", "limitations": "No control group; preliminary experience; some patients needed additional surgery or laser treatment; described as 'preliminary'.", "followUp": "15.2 months", "plainFinding": "Most symptom-free after laser treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/21927795/", "sourceText": "A pilonidal sinus usually contains hair and extensive vascularization due to inflammation, which theoretically gives Nd-YAG laser waves the potential to destroy the deep fistula systems of the sinus without affecting the overlying skin. We describe our preliminary experience with Nd-YAG laser waves in the treatment of pilonidal sinus. A total of 41 consecutive patients with pilonidal sinus underwent the intended Nd-YAG laser treatment. Structured telephone interviews were carried out in 37 patients (90%). The median duration of treatment and observation time were 5.1 months and 15.2 months, respectively. Three patients (7%) received additional surgery: two had granulomas removed via a minor excision, and one requested more traditional surgery. At follow-up, 28 out of the 37 patients (75.7%) reported freedom from symptoms without supplementary treatment, and 30 (81%) were symptom-free after supplementary laser treatment and minimal surgery, if needed. We have identified a potential treatment for pilonidal sinus that is extremely gentle compared with conventional surgery. We aim to substantially increase the cohort of patients undergoing this treatment and follow up these patients with a register-based technique with a comparable control group. The Nd-YAG laser may prove to be an attractive treatment alternative for pilonidal sinus.", "provenance": [ { "field": "n", "quote": "A total of 41 consecutive patients with pilonidal sinus underwent the intended Nd-YAG laser treatment." }, { "field": "population", "quote": "A total of 41 consecutive patients with pilonidal sinus underwent the intended Nd-YAG laser treatment." }, { "field": "intervention", "quote": "Nd-YAG laser waves in the treatment of pilonidal sinus" }, { "field": "comparator", "quote": "We aim to substantially increase the cohort of patients undergoing this treatment and follow up these patients with a register-based technique with a comparable control group." }, { "field": "primaryOutcome", "quote": "At follow-up, 28 out of the 37 patients (75.7%) reported freedom from symptoms without supplementary treatment" }, { "field": "result", "quote": "At follow-up, 28 out of the 37 patients (75.7%) reported freedom from symptoms without supplementary treatment, and 30 (81%) were symptom-free after supplementary laser treatment and minimal surgery, if needed." } ] }, { "id": "pmid:20002644", "pmid": "20002644", "doi": "10.1111/j.1524-4725.2009.01387.x", "nctId": null, "pmcid": null, "title": "Evaluation of 60 patients with pilonidal sinus treated with laser epilation after surgery", "firstAuthor": "Oram", "multipleAuthors": true, "journal": "Dermatol Surg", "year": 2010, "design": "retrospective", "n": 60, "nField": "reported", "population": "patients who had surgery for pilonidal sinus disease", "intervention": "laser hair removal (alexandrite laser) after surgery", "comparator": "no comparator group; historical recurrence rates implied", "primaryOutcome": "recurrence of pilonidal sinus disease", "result": "13.3% recurrence rate after average 4.8 years follow-up", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small retrospective chart review with no control group, so it can't prove laser treatment caused the lower recurrence.", "directness": "direct", "limitations": "Retrospective design, no comparison group, relies partly on patient telephone interviews.", "followUp": "4.8 +/- 0.3 years", "plainFinding": "Fewer recurrences after laser hair removal.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/20002644/", "sourceText": "BACKGROUND: The surgical treatments for pilonidal sinus disease often result in recurrences, and the patients risk requiring multiple surgical interventions. OBJECTIVE: To evaluate the role of alexandrite laser hair removal after surgery in pilonidal sinus disease. METHODS: Sixty patients who underwent surgical treatment of pilonidal sinus disease and were treated with a 755-nm alexandrite laser after surgery between 1999 and 2007 were examined retrospectively. The charts were reviewed, and the patients were interviewed on the telephone about their post-laser period and recurrence. The laser parameters, patient history, and surgical details were recorded. RESULTS: The overall recurrence rate was 13.3%, after a mean follow-up period +/- standard error of the mean of 4.8 +/- 0.3 years. The mean number of laser treatment was 2.7 +/- 0.1. Seventy-five percent of the recurrences were detected after a follow-up period of 5 to 9 years. Fifty percent of the recurrent cases had drainage and secondary intention before the laser epilation. CONCLUSION: Our results strongly suggest that laser hair removal after surgical interventions in pilonidal sinus disease decreases the risk of recurrence over the long term.", "provenance": [ { "field": "n", "quote": "Sixty patients who underwent surgical treatment of pilonidal sinus disease" }, { "field": "population", "quote": "Sixty patients who underwent surgical treatment of pilonidal sinus disease and were treated with a 755-nm alexandrite laser after surgery between 1999 and 2007" }, { "field": "intervention", "quote": "treated with a 755-nm alexandrite laser after surgery" }, { "field": "comparator", "quote": "The surgical treatments for pilonidal sinus disease often result in recurrences" }, { "field": "primaryOutcome", "quote": "the patients were interviewed on the telephone about their post-laser period and recurrence" }, { "field": "result", "quote": "The overall recurrence rate was 13.3%, after a mean follow-up period +/- standard error of the mean of 4.8 +/- 0.3 years." } ] }, { "id": "pmid:19586514", "pmid": "19586514", "doi": "10.1111/j.1468-3083.2009.03147.x", "nctId": null, "pmcid": null, "title": "Effect of hair removal by Nd:YAG laser on the recurrence of pilonidal sinus", "firstAuthor": "Badawy", "multipleAuthors": true, "journal": "J Eur Acad Dermatol Venereol", "year": 2009, "design": "rct", "n": 25, "nField": "reported", "population": "young men with pilonidal sinus (a chronic skin infection near the tailbone) after surgical removal", "intervention": "Nd:YAG laser hair removal in the area after surgery", "comparator": "surgery alone, no laser hair removal", "primaryOutcome": "return of the pilonidal sinus needing more surgery", "result": "none of the laser group needed more surgery, while 7 of 10 in the no-laser group had the condition come back", "resultDirection": "benefit", "quality": "low", "qualityWhy": "very small study with only 25 patients and it is not clear if treatment was randomly assigned.", "directness": "direct", "limitations": "Very small sample size, unclear randomization method, short-to-moderate follow-up, single-center, all male patients.", "followUp": "12 to 23 months", "plainFinding": "Fewer recurrences after laser hair removal.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/19586514/", "sourceText": "BACKGROUND: Pilonidal sinus (PNS) is chronic inflammatory process of the skin in the natal cleft. Management of PNS is mainly surgical. Although different types of surgery have been performed, the recurrence rate is still high. OBJECTIVE: To evaluate the effectiveness of laser hair removal (LHR) in the natal cleft area on the recurrence rate of PNS as an adjuvant therapy after surgical treatment. METHODS: Twenty five patients with PNS were included in this study. Fifteen patients underwent LHR treatment using Nd:YAG laser after surgical excision of PNS (Patients group) while ten subjects with PNS did not do LHR and served as a control group. RESULTS: All of the patients were male patients. Their age ranged from 17 to 29 years with a mean of 21.60 +/- 3.13 years. They had Fitzpatrick skin type III, IV and V. The patients have got 3 to 8 sessions of LHR (mean 4.87 +/- 1.64). Follow up period lasted between 12 to 23 months. None of the patients, who underwent LHR, has required further surgical treatment to date. Seven patients out of ten in the control group have developed recurrent PNS. Pain was the most frequent side effect and it was seen in 6 patients (40%). CONCLUSION: LHR can prevent the recurrence of PNS. LHR should be advised as an essential adjuvant treatment after surgical excision of PNS. In non-complicated recurrent PNS, LHR is strongly advocated to be started before and continued after doing surgical treatment.", "provenance": [ { "field": "n", "quote": "Twenty five patients with PNS were included in this study." }, { "field": "population", "quote": "Fifteen patients underwent LHR treatment using Nd:YAG laser after surgical excision of PNS (Patients group) while ten subjects with PNS did not do LHR and served as a control group." }, { "field": "intervention", "quote": "laser hair removal (LHR) in the natal cleft area" }, { "field": "comparator", "quote": "ten subjects with PNS did not do LHR and served as a control group" }, { "field": "primaryOutcome", "quote": "the recurrence rate of PNS" }, { "field": "result", "quote": "None of the patients, who underwent LHR, has required further surgical treatment to date. Seven patients out of ten in the control group have developed recurrent PNS." }, { "field": "followUp", "quote": "Follow up period lasted between 12 to 23 months." } ] }, { "id": "pmid:19273968", "pmid": "19273968", "doi": "10.1007/DCR.0b013e3181972505", "nctId": null, "pmcid": null, "title": "Long-term effects of postoperative razor epilation in pilonidal sinus disease", "firstAuthor": "Petersen", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 2009, "design": "retrospective", "n": 504, "nField": "reported", "population": "patients who had surgery for pilonidal sinus disease", "intervention": "postoperative razor hair removal (epilation)", "comparator": "no postoperative epilation", "primaryOutcome": "recurrence of pilonidal sinus disease", "result": "patients who used razor epilation after surgery had higher recurrence than those who did not", "resultDirection": "harm", "quality": "low", "qualityWhy": "this was a retrospective telephone follow-up where patients self-selected whether to do epilation, so the groups may differ in other ways besides hair removal.", "directness": "indirect", "limitations": "Retrospective design, self-selected adherence to epilation recommendation, follow-up via telephone interview rather than clinical examination.", "followUp": "11.3 (standard deviation, 6.4) years", "plainFinding": "Razor hair removal worsened recurrence; laser not tested", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/19273968/", "sourceText": "PURPOSE: To study potential benefits of postoperative epilation after pilonidal sinus surgery, the long-term effect of hair removal on pilonidal recurrence was investigated. METHODS: A total of 1,960 patients with pilonidal sinus treated surgically from 1980 to 1996 in three hospitals of the Deutsche Bundeswehr were eligible for the study. Regular hair removal with a razor was recommended for all patients after surgery. A randomly selected sample of 504 patients was contacted for a follow-up telephone interview. RESULTS: The mean follow-up time was 11.3 (standard deviation, 6.4) years. Overall, pilonidal sinus disease recurred in 111 (22 percent) of the 504 patients. A total of 113 patients followed the recommendation to perform epilation (mean duration, 7.5 months), and 391 patients did not. Recurrence was observed in 30.1 percent (34/113) of patients who performed postoperative epilation and in 19.7 percent (77/391) of patients who did not perform postoperative epilation (P = 0.01). CONCLUSIONS: Razor hair removal increases the rate of long-term recurrence after surgery for pilonidal sinus disease and therefore should not be recommended. However, the rationale for hair removal in pilonidal sinus disease is compelling. Other epilation techniques such as laser hair removal should be investigated in appropriate studies.", "provenance": [ { "field": "population", "quote": "A total of 1,960 patients with pilonidal sinus treated surgically from 1980 to 1996" }, { "field": "n", "quote": "A randomly selected sample of 504 patients was contacted for a follow-up telephone interview." }, { "field": "intervention", "quote": "Regular hair removal with a razor was recommended for all patients after surgery." }, { "field": "comparator", "quote": "391 patients did not" }, { "field": "primaryOutcome", "quote": "pilonidal sinus disease recurred in 111 (22 percent) of the 504 patients" }, { "field": "result", "quote": "Recurrence was observed in 30.1 percent (34/113) of patients who performed postoperative epilation and in 19.7 percent (77/391) of patients who did not perform postoperative epilation (P = 0.01)." }, { "field": "followUp", "quote": "The mean follow-up time was 11.3 (standard deviation, 6.4) years." } ] }, { "id": "pmid:21686748", "pmid": "21686748", "doi": "10.1136/bcr.07.2008.0552", "nctId": null, "pmcid": "PMC3027563", "title": "Nd-YAG laser treatment in a patient with complicated pilonidal cysts", "firstAuthor": "Lindholt", "multipleAuthors": true, "journal": "BMJ Case Rep", "year": 2009, "design": "case-series", "n": 16, "nField": "reported", "population": "patients with recurrent or suppurative pilonidal cysts", "intervention": "Nd-YAG laser treatment of the cyst", "comparator": "no comparison group (case series); mentioned as alternative to open surgery", "primaryOutcome": "cyst recurrence after treatment", "result": "no recurrence at 3-month follow-up in all treated patients, including suppurative cases", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a small, uncontrolled case series with very short follow-up, so it cannot reliably show the laser works.", "directness": "direct", "limitations": "No control group, very small number of patients, short follow-up period.", "followUp": "3-month follow-up", "plainFinding": "No recurrence after laser treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/21686748/", "sourceText": "A 38-year-old woman with a recurrent suppurative pilonidal cyst was successfully treated causally with an Nd-YAG (neodymium-doped yttrium aluminium garnet) laser, and with no recurrence at 3-month follow-up. A similar success was observed for another 15 consecutively treated patients, including suppurative cases. The effect could be attributable to the ability of the YAG laser to operate at a wavelength of 1064 nm and to penetrate the skin to levels deeper than that of most other lasers before the energy is absorbed in melanin and oxyhaemoglobin. Consequently, the contents of the cyst can be reached and destroyed. The treatment could be a very attractive alternative to open surgery.", "provenance": [ { "field": "n", "quote": "A similar success was observed for another 15 consecutively treated patients, including suppurative cases." }, { "field": "population", "quote": "A 38-year-old woman with a recurrent suppurative pilonidal cyst" }, { "field": "intervention", "quote": "treated causally with an Nd-YAG (neodymium-doped yttrium aluminium garnet) laser" }, { "field": "comparator", "quote": "The treatment could be a very attractive alternative to open surgery." }, { "field": "primaryOutcome", "quote": "with no recurrence at 3-month follow-up" }, { "field": "result", "quote": "successfully treated causally with an Nd-YAG (neodymium-doped yttrium aluminium garnet) laser, and with no recurrence at 3-month follow-up" } ] }, { "id": "pmid:18570763", "pmid": "18570763", "doi": null, "nctId": null, "pmcid": null, "title": "[Treatment of pilonidal cyst with Nd-YAG laser]", "firstAuthor": "Lindholt", "multipleAuthors": true, "journal": "Ugeskr Laeger", "year": 2008, "design": "case-series", "n": 1, "nField": "reported", "population": "a 23 year-old woman with a nonsupporative pilonidal cyst", "intervention": "Nd-YAG laser treatment", "comparator": "none (no comparator, single case)", "primaryOutcome": "whether the cyst resolved without recurrence", "result": "successfully treated with no recurrence after 9 months", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show whether the treatment generally works.", "directness": "direct", "limitations": "Only one patient was treated, with no comparison group, so results may not generalize.", "followUp": "9 months", "plainFinding": "Cyst resolved in one patient.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/18570763/", "sourceText": "A 23 year-old woman with a nonsupporative pilonidal cyst was successfully treated causally with Nd-YAG laser, and without any recidivate after 9 months follow-up. The mechanism is presumed to be that YAG-laser has a wave-length of 1064 nm. Consequently, the wave penetration through the skin is deeper than most other lasers before the energy is absorbed in melanin and oxyhaemoglobin, so the contents of the cyst can be reached and destroyed. The treatment could be a very attractive alternative to open surgery.", "provenance": [ { "field": "n", "quote": "A 23 year-old woman with a nonsupporative pilonidal cyst" }, { "field": "population", "quote": "A 23 year-old woman with a nonsupporative pilonidal cyst" }, { "field": "intervention", "quote": "was successfully treated causally with Nd-YAG laser" }, { "field": "comparator", "quote": "The treatment could be a very attractive alternative to open surgery." }, { "field": "primaryOutcome", "quote": "without any recidivate after 9 months follow-up" }, { "field": "result", "quote": "was successfully treated causally with Nd-YAG laser, and without any recidivate after 9 months follow-up" } ] }, { "id": "pmid:17664085", "pmid": "17664085", "doi": "10.1016/j.bjps.2007.06.022", "nctId": null, "pmcid": null, "title": "Laser depilation and hygiene: preventing recurrent pilonidal sinus disease", "firstAuthor": "Conroy", "multipleAuthors": true, "journal": "J Plast Reconstr Aesthet Surg", "year": 2008, "design": "case-series", "n": 14, "nField": "reported", "population": "patients with recurrent pilonidal sinus disease after surgery", "intervention": "laser hair removal plus personal hygiene advice", "comparator": "none (before-after comparison)", "primaryOutcome": "recurrence of pilonidal sinus disease", "result": "none of the patients had disease come back within a year", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This was a very small study of only 14 patients with no comparison group, so it can't reliably show the laser caused the improvement.", "directness": "direct", "limitations": "Small sample size, no control group, retrospective review of only 12 patients completing treatment.", "followUp": "1-year follow up", "plainFinding": "No recurrence after laser hair removal.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/17664085/", "sourceText": "BACKGROUND: Pilonidal sinus disease of the natal cleft is a painful and debilitating condition which often recurs despite multiple surgical undertakings. We describe the long pulsed alexandrite laser for hair depilation and the role of personal hygiene, which is often overlooked when treating this disease, as an adjunct to preventing recurrent pilonidal sinus disease. METHODS: A review of 14 patients who underwent laser hair depilation in the natal cleft following pilonidal sinus surgery. The majority of patients had recurrent disease and had undergone numerous surgical procedures (range 1-5, mean 2.07) All patients were given advice regarding meticulous personal hygiene at the time of consultation. RESULTS: 12 patients received the full course of treatment (three treatments, 6-weekly) followed by 'top-up' treatments as required (mean number of treatments 3.9). None of the patients developed recurrent disease at 1-year follow up and, to date, none have required further surgery. CONCLUSION: Laser hair depilation is a useful adjunct in preventing the recurrence of pilonidal sinus disease and should be offered routinely to all patients. This coupled with patient education regarding personal hygiene reduces the risk of developing recurrent pilonidal sinus disease.", "provenance": [ { "field": "n", "quote": "A review of 14 patients who underwent laser hair depilation" }, { "field": "population", "quote": "following pilonidal sinus surgery" }, { "field": "intervention", "quote": "laser hair depilation in the natal cleft" }, { "field": "comparator", "quote": "All patients were given advice regarding meticulous personal hygiene at the time of consultation." }, { "field": "primaryOutcome", "quote": "None of the patients developed recurrent disease at 1-year follow up" }, { "field": "result", "quote": "None of the patients developed recurrent disease at 1-year follow up and, to date, none have required further surgery." } ] }, { "id": "pmid:16983902", "pmid": "16983902", "doi": null, "nctId": null, "pmcid": null, "title": "Laser and light treatments for pilonidal cysts", "firstAuthor": "Sadick", "multipleAuthors": true, "journal": "Cutis", "year": 2006, "design": "case-series", "n": 5, "nField": "reported", "population": "patients with pilonidal cysts", "intervention": "diode laser or intense pulsed light (IPL) treatment", "comparator": "traditional conservative treatment or surgery (historical, not directly compared)", "primaryOutcome": "recurrence of pilonidal cyst", "result": "4 of 5 patients stayed recurrence free for 7 months to over 36 months; one patient recurred after 36 months, a longer remission than before", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a tiny report of only 5 patients with no comparison group, so it cannot reliably show the treatment works.", "directness": "direct", "limitations": "Very small number of patients, no control group, and no statistical comparison to standard treatments.", "followUp": "7 months to more than 36 months", "plainFinding": "Fewer recurrences after laser treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/16983902/", "sourceText": "Pilonidal (nest of hair) cysts are foreign body reactions accompanied by chronic inflammation. Current accepted treatments include the traditional conservative treatments or aggressive surgery. However, these modalities exhibit a high rate of disease recurrence, especially in patients with hirsutism; therefore, affected patients often are subjected to repeated surgical interventions. This report describes 5 patients treated with either a diode laser or intense pulsed light (IPL), which produced results leaving the patients recurrence free. Four of 5 patients remained recurrence free for 7 months to more than 36 months; one patient experienced a recurrence after 36 months, which was longer than his previous remission. These results suggest laser and IPL technologies are alternatives to traditional surgical intervention, providing potentially longer disease-free intervals and fewer recurrences.", "provenance": [ { "field": "population", "quote": "Pilonidal (nest of hair) cysts are foreign body reactions accompanied by chronic inflammation." }, { "field": "intervention", "quote": "5 patients treated with either a diode laser or intense pulsed light (IPL)" }, { "field": "comparator", "quote": "Current accepted treatments include the traditional conservative treatments or aggressive surgery." }, { "field": "primaryOutcome", "quote": "produced results leaving the patients recurrence free" }, { "field": "result", "quote": "Four of 5 patients remained recurrence free for 7 months to more than 36 months; one patient experienced a recurrence after 36 months, which was longer than his previous remission." }, { "field": "n", "quote": "5 patients treated with either a diode laser or intense pulsed light (IPL)" } ] }, { "id": "pmid:16808209", "pmid": "16808209", "doi": null, "nctId": null, "pmcid": null, "title": "Treatment of pilonidal disease with laser epilation", "firstAuthor": "Schulze", "multipleAuthors": true, "journal": "Am Surg", "year": 2006, "design": "case-series", "n": 23, "nField": "reported", "population": "patients with recurrent pilonidal disease who had prior drainage or excision", "intervention": "laser hair removal added after surgical excision of the pilonidal sinus", "comparator": "no comparison group; before/after same patients", "primaryOutcome": "recurrence of folliculitis or need for further surgery", "result": "all 19 patients remaining in follow-up had no recurrence of folliculitis or need for further surgery", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a small, uncontrolled case series without a comparison group, so it cannot reliably show the laser itself caused the improvement.", "directness": "direct", "limitations": "No control group; small sample; some patients lost to follow-up; wound dehiscence occurred in several patients.", "followUp": "", "plainFinding": "No recurrence after laser hair removal.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/16808209/", "sourceText": "Pilonidal disease is a debilitating, chronic disease of the natal cleft. It mainly involves the sacrococcygeal region and the presentation varies from asymptomatic pits to painful draining abscesses. Treatment options vary from observation to wide excision. Unfortunately, surgical treatment often results in recurrence. The etiologic agent remains in question, as does the optimal treatment. Our objective was to assess the efficacy of laser epilation as an adjunctive therapy to surgical excision of the pilonidal sinus. Eighteen men and five women were treated with laser epilation in our office from 2001 to 2004. All patients had experienced recurrent folliculitis and had undergone some form of drainage procedure or prior excision. After surgical excision of the affected area, a Vasculite Plus laser was used for the epilation treatments. Each session involved 9 to 12 treatments and the patients underwent an average of two sessions. All 19 of the patients that remain in follow-up report no recurrence of their folliculitis or need for further surgical procedures. During treatment, six of the men and one of the women experienced a superficial wound dehiscence. All healed with local wound care and continued laser treatments. Laser epilation is an effective adjunctive therapy for the treatment of pilonidal disease. Although not curative in and of itself, the removal of hair allows better healing and decreases the chance of recurrence by removal of a significant etiology of pilonidal disease.", "provenance": [ { "field": "n", "quote": "Eighteen men and five women were treated with laser epilation in our office from 2001 to 2004." }, { "field": "population", "quote": "All patients had experienced recurrent folliculitis and had undergone some form of drainage procedure or prior excision." }, { "field": "intervention", "quote": "After surgical excision of the affected area, a Vasculite Plus laser was used for the epilation treatments." }, { "field": "comparator", "quote": "Eighteen men and five women were treated with laser epilation in our office from 2001 to 2004." }, { "field": "primaryOutcome", "quote": "All 19 of the patients that remain in follow-up report no recurrence of their folliculitis or need for further surgical procedures." }, { "field": "result", "quote": "All 19 of the patients that remain in follow-up report no recurrence of their folliculitis or need for further surgical procedures." } ] }, { "id": "pmid:15996432", "pmid": "15996432", "doi": "10.1111/j.1524-4725.2005.31601", "nctId": null, "pmcid": null, "title": "Successful treatment of recurrent pilonidal sinus with laser epilation", "firstAuthor": "Landa", "multipleAuthors": true, "journal": "Dermatol Surg", "year": 2005, "design": "case-series", "n": 6, "nField": "reported", "population": "young men with recurrent pilonidal disease, some with prior surgery", "intervention": "laser hair removal in the natal cleft (alexandrite laser or intense pulsed light), 3 to 11 sessions", "comparator": "no comparator group", "primaryOutcome": "resolution of folliculitis and need for further surgery", "result": "all patients improved with no further surgery needed and no complications", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This was a very small study of only six patients with no comparison group, so it cannot reliably show the treatment works.", "directness": "direct", "limitations": "Very small sample size, no control group, no blinding mentioned.", "followUp": "", "plainFinding": "Fewer recurrences, no more surgery needed.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/15996432/", "sourceText": "BACKGROUND: Pilonidal disease is a chronic disease of the natal cleft. Recurrent follicular infection is the causative factor. Surgical treatment has a significant failure rate, and recurrence is common. Laser removal of hair in the natal cleft could be an alternative to surgery. OBJECTIVE: To determine the effectiveness of laser hair removal in the natal cleft on pilonidal disease. METHODS: Six young men with recurrent pilonidal disease were treated with laser epilation in our clinic from 2000 to 2003. Most patients had a history of one or more surgical treatments in the area, and all patients had suffered recurrent folliculitis for years. An alexandrite laser was mostly used, although, occasionally, an intense pulsed light device was used. The number of epilation treatments ranged from 3 to 11, performed at 6- to 8-week intervals. RESULTS: All patients experienced progressive resolution of the folliculitis with the laser epilation treatments. No more surgical treatments have been needed. The treatments were simple and quick, and there were no complications. CONCLUSION: Laser epilation of the natal cleft should be considered a first choice treatment for recurrent pilonidal disease. Preventive laser epilation of the natal cleft in patients with recurrent folliculitis could avoid future surgery.", "provenance": [ { "field": "n", "quote": "Six young men with recurrent pilonidal disease were treated with laser epilation" }, { "field": "population", "quote": "Six young men with recurrent pilonidal disease were treated with laser epilation in our clinic from 2000 to 2003." }, { "field": "intervention", "quote": "An alexandrite laser was mostly used, although, occasionally, an intense pulsed light device was used. The number of epilation treatments ranged from 3 to 11, performed at 6- to 8-week intervals." }, { "field": "comparator", "quote": "Six young men with recurrent pilonidal disease were treated with laser epilation in our clinic from 2000 to 2003." }, { "field": "primaryOutcome", "quote": "To determine the effectiveness of laser hair removal in the natal cleft on pilonidal disease." }, { "field": "result", "quote": "All patients experienced progressive resolution of the folliculitis with the laser epilation treatments. No more surgical treatments have been needed." } ] }, { "id": "pmid:12470518", "pmid": "12470518", "doi": "10.1080/147641702320602564", "nctId": null, "pmcid": null, "title": "Recurrent pilonidal sinus treated with epilation using a ruby laser", "firstAuthor": "Lavelle", "multipleAuthors": true, "journal": "J Cosmet Laser Ther", "year": 2002, "design": "case-series", "n": 1, "nField": "reported", "population": "a 33-year-old man with recurrent pilonidal sinus", "intervention": "ruby laser hair removal (epilation) applied to the scar area", "comparator": "no comparator (single patient, before/after)", "primaryOutcome": "healing of the sinus without recurrence", "result": "the sinus healed and had not recurred 6 months after the last treatment", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report with no comparison group, so it cannot show whether the laser caused the improvement.", "directness": "direct", "limitations": "only one patient was studied, there was no control group, and follow-up was short.", "followUp": "6 months", "plainFinding": "Sinus healed, no recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/12470518/", "sourceText": "BACKGROUND: Surgical treatment of pilonidal sinus disease of the natal cleft has a significant failure rate. Reported here is the case of a 33-year-old man who first presented at the age of 18 with a pilonidal sinus. METHOD: The patient's scar was treated with a ruby laser using a pulse length of 2 ms and energy densities of 6.0-7.2 J/cm(2). Treatment was performed five times at 6-week intervals. RESULT: The sinus healed and has not recurred to date, 6 months after the last treatment. CONCLUSION: It is felt that there may be a future for this treatment, either as primary treatment or as an adjunct to surgery in refractive cases. It could also be useful in preventing the growth of hairs into wounds that have been left open and allowed to granulate.", "provenance": [ { "field": "n", "quote": "a 33-year-old man who first presented at the age of 18 with a pilonidal sinus" }, { "field": "population", "quote": "a 33-year-old man who first presented at the age of 18 with a pilonidal sinus" }, { "field": "intervention", "quote": "The patient's scar was treated with a ruby laser using a pulse length of 2 ms and energy densities of 6.0-7.2 J/cm(2)." }, { "field": "comparator", "quote": "Treatment was performed five times at 6-week intervals." }, { "field": "primaryOutcome", "quote": "The sinus healed and has not recurred to date, 6 months after the last treatment." }, { "field": "result", "quote": "The sinus healed and has not recurred to date, 6 months after the last treatment." } ] }, { "id": "pmid:11890622", "pmid": "11890622", "doi": null, "nctId": null, "pmcid": "PMC2503766", "title": "Laser depilation of the natal cleft--an aid to healing the pilonidal sinus", "firstAuthor": "Odili", "multipleAuthors": true, "journal": "Ann R Coll Surg Engl", "year": 2002, "design": "case-series", "n": 14, "nField": "reported", "population": "patients with recurrent pilonidal disease", "intervention": "laser hair removal (depilation) of natal cleft as an adjunct to treatment", "comparator": "no comparator (case series, before/after)", "primaryOutcome": "healing of pilonidal sinus", "result": "all patients healed, with 4 needing further laser treatment; procedure was painful but had no complications", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This was a very small study of only 14 patients with no comparison group, so it can't prove the laser itself caused healing.", "directness": "direct", "limitations": "Small sample size, no control group, retrospective follow-up via postal questionnaire.", "followUp": "Over a 5-year period", "plainFinding": "All healed after laser hair removal.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/11890622/", "sourceText": "BACKGROUND: Pilonidal disease is common. Excessive hair growth in the natal cleft is thought to be a factor in initiating these sinuses. It is chronic and intermittent in nature and treatment can be difficult. Hair removal by shaving or use of creams is often advised as a compliment to surgical treatments. However, access to the natal cleft can be difficult. Laser removal of hair in the natal cleft is considered as an aid to healing the pilonidal sinus. PATIENTS AND METHODS: Over a 5-year period, 14 patients with recurrent pilonidal disease were treated in our unit with laser depilation. They were all contacted by postal questionnaire, and those with ongoing disease were asked to return to the clinic for evaluation and possible further treatment. RESULTS: All patients returned the postal questionnaire. Of the 14 patients, 4 had on-going disease and received further depilation with the Alexandrite laser. All are now healed with no reported complications. All patients found the procedure painful and received local anaesthetic. CONCLUSIONS: Laser depilation in the natal cleft is by no means a cure for pilonidal disease. Removal of hair by this method represents an alternative and effective method of hair removal and, although long lasting, is only temporary. However, it allows the sinuses to heal rapidly. It is relatively safe, and simple to teach, with few complications. It should thus be considered as an aid to healing the problem pilonidal sinus.", "provenance": [ { "field": "n", "quote": "14 patients with recurrent pilonidal disease were treated in our unit with laser depilation" }, { "field": "population", "quote": "14 patients with recurrent pilonidal disease" }, { "field": "intervention", "quote": "Laser removal of hair in the natal cleft is considered as an aid to healing the pilonidal sinus" }, { "field": "comparator", "quote": "Over a 5-year period, 14 patients with recurrent pilonidal disease were treated in our unit with laser depilation" }, { "field": "primaryOutcome", "quote": "allows the sinuses to heal rapidly" }, { "field": "result", "quote": "All are now healed with no reported complications." } ] }, { "id": "pmid:11199837", "pmid": "11199837", "doi": "10.1089/clm.1999.17.151", "nctId": null, "pmcid": null, "title": "Diamond-shaped optical fiber delivery system", "firstAuthor": "Walfisch", "multipleAuthors": true, "journal": "J Clin Laser Med Surg", "year": 1999, "design": "lab", "n": null, "nField": "not-reported", "population": "Patients undergoing various surgical procedures (perianal fistulectomy, hemorrhoidectomy, condyloma removal, and pilonidal cyst/sinus excision)", "intervention": "A new diamond-shaped tip laser fiber delivery system (Nd:YAG and diode lasers) used for cutting and coagulating tissue", "comparator": "Other commercially available optical fiber delivery systems", "primaryOutcome": "Durability and performance of the laser delivery device during surgery", "result": "The diamond-shaped tip was more durable, could be reused many times, and worked well during cutting and coagulating with no technical problems", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a device engineering report describing a laser delivery tool tested across several surgery types, with no patient numbers, no comparison group outcomes, and no clinical results specific to pilonidal cysts.", "directness": "indirect", "limitations": "No participant numbers reported, no clinical outcome measures (like healing or recurrence) given, and pilonidal cyst surgery is only one of several procedures mentioned without separate results.", "followUp": "", "plainFinding": "Device performed well, no cyst outcomes reported", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/11199837/", "sourceText": "OBJECTIVE: Physicians who use laser systems are looking for new fiberoptic delivery systems with better performance. We searched for a delivery system with high power and with a tip of high durability that may be reused many times. SUMMARY BACKGROUND DATA: The delivery systems currently found on the market can burn and break easily. The surgeon may either finish the surgery with a damaged delivery system, or have to switch to a new one during surgery, thus increasing the inconvenience and cost of the surgery. METHODS: Distal tips of fibers used with Nd:YAG and diode lasers have been shaped and polished according to their specific function, including excision, vaporization, and coagulation of tissue. RESULTS: We have developed several prototypes of optical fiber delivery systems, and in particular, we have developed a prototype of a delivery system, called the Diamond-Shaped Optical Fiber Delivery System, or Diamond. By making the tip of an optical fiber diamond shaped, we are able to obtain greater mechanical resistance than that of other delivery systems that were tested in our laboratory. In the Colorectal Unit, we applied it in surgical procedures such as perianal fistulectomy, hemorrhoidectomy, and excision of condilomata acuminata and pilonidal cyst and sinuses. During cutting and coagulating, the system performed well with no technical problems. CONCLUSIONS: A new delivery system (Diamond) gave satisfactory performance during surgical operations. Its main component, the diamond-shaped distal end, provided high durability and was reused many times, thus improving the quality of operations and reducing expenses greatly.", "provenance": [ { "field": "intervention", "quote": "Distal tips of fibers used with Nd:YAG and diode lasers have been shaped and polished according to their specific function, including excision, vaporization, and coagulation of tissue." }, { "field": "intervention", "quote": "we have developed a prototype of a delivery system, called the Diamond-Shaped Optical Fiber Delivery System, or Diamond" }, { "field": "population", "quote": "we applied it in surgical procedures such as perianal fistulectomy, hemorrhoidectomy, and excision of condilomata acuminata and pilonidal cyst and sinuses" }, { "field": "comparator", "quote": "The delivery systems currently found on the market can burn and break easily." }, { "field": "primaryOutcome", "quote": "We searched for a delivery system with high power and with a tip of high durability that may be reused many times." }, { "field": "result", "quote": "During cutting and coagulating, the system performed well with no technical problems." }, { "field": "result", "quote": "Its main component, the diamond-shaped distal end, provided high durability and was reused many times, thus improving the quality of operations and reducing expenses greatly." } ] }, { "id": "pmid:10805943", "pmid": "10805943", "doi": "10.1002/(sici)1096-9101(2000)26:4<380::aid-lsm6>3.0.co;2-x", "nctId": null, "pmcid": null, "title": "Nd:YAG laser surgery for the excision of pilonidal cysts: a comparison with traditional techniques", "firstAuthor": "Palesty", "multipleAuthors": true, "journal": "Lasers Surg Med", "year": 2000, "design": "retrospective", "n": null, "nField": "not-reported", "population": "people having surgery to remove pilonidal cysts", "intervention": "Nd:YAG laser cyst removal surgery", "comparator": "standard (traditional) cyst removal surgery", "primaryOutcome": "pain, time off work, and patient satisfaction after surgery", "result": "laser patients returned to work sooner and had less pain than those with traditional surgery", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective comparison without randomization and no reported number of patients, so bias and small sample size are likely.", "directness": "direct", "limitations": "Retrospective design, no patient numbers given, pain and satisfaction assessed partly by phone questionnaire after the fact.", "followUp": "", "plainFinding": "Faster return to work, less pain.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/10805943/", "sourceText": "BACKGROUND AND OBJECTIVE: Nd:YAG laser photothermal ablation has been accepted as a treatment modality for hemorrhoidal disease. There is little reported on its use in treating pilonidal disease. We hypothesized that laser would be an excellent tool for pilonidal cystectomy, facilitating improved outcome and patient satisfaction. STUDY DESIGN/MATERIALS AND METHODS: A 5-year retrospective study was performed comparing Nd:YAG laser to the standard surgical technique. A telephone questionnaire addressing the length of time the cyst was debilitating both preoperatively and postoperatively as well as length of convalescent time before return to work was administered. Pain was assessed by using an analog pain scale. RESULTS: Operative time for the traditional pilonidal cystectomy was 20 minutes longer than Nd:YAG laser cystectomy. Postoperative hospital stay was similar. Laser patients returned to work an average of 2.4 days earlier, and their postoperative pain was less than those treated traditionally. CONCLUSION: In an era when the medical consumer makes decisions based on the efficacy of treatment by using criteria such as pain, length of hospitalization, and speed of return to work, Nd:YAG lasers have emerged as a surgical tool that can fulfill these criteria for certain procedures. Patient postoperative satisfaction after laser excision was greater when compared with those who had traditional excisions. Postoperative pain was less, as was the pain experienced during the first week of recovery. Cost for both was comparable.", "provenance": [ { "field": "population", "quote": "comparing Nd:YAG laser to the standard surgical technique" }, { "field": "intervention", "quote": "Nd:YAG laser cystectomy" }, { "field": "comparator", "quote": "the traditional pilonidal cystectomy" }, { "field": "primaryOutcome", "quote": "addressing the length of time the cyst was debilitating both preoperatively and postoperatively as well as length of convalescent time before return to work" }, { "field": "result", "quote": "Laser patients returned to work an average of 2.4 days earlier, and their postoperative pain was less than those treated traditionally." } ] }, { "id": "pmid:12743878", "pmid": "12743878", "doi": null, "nctId": null, "pmcid": null, "title": "[Day-surgery treatment of pilonidal sinus]", "firstAuthor": "Calbo", "multipleAuthors": true, "journal": "Chir Ital", "year": 1997, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus disease (acute and chronic phases)", "intervention": "carbon-dioxide laser used with open surgical treatment", "comparator": "open treatment without laser / closed treatment method", "primaryOutcome": "complications and healing time", "result": "laser said to help prevent complications and speed healing, but no data given", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a narrative discussion of the authors' experience with no numbers, control group, or data reported.", "directness": "direct", "limitations": "No participant numbers, no study design details, no statistical results reported; appears to be an opinion/experience-based discussion rather than a controlled study.", "followUp": "", "plainFinding": "Authors say laser helped, no data.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/12743878/", "sourceText": "Authors discuss ethiopathogenus of pilonidal disease after a historical background and support acquired-congenital theory. Open and closed treatment are reported on the acute and chronic phases, highlighting economical advantages of closed method. Carbon-dioxide laser on Authors experience was very useful to prevent complications and to shorten healing time in open method.", "provenance": [ { "field": "intervention", "quote": "Carbon-dioxide laser on Authors experience was very useful to prevent complications and to shorten healing time in open method." }, { "field": "result", "quote": "Carbon-dioxide laser on Authors experience was very useful to prevent complications and to shorten healing time in open method." }, { "field": "primaryOutcome", "quote": "to prevent complications and to shorten healing time" }, { "field": "population", "quote": "Open and closed treatment are reported on the acute and chronic phases" }, { "field": "comparator", "quote": "Open and closed treatment are reported on the acute and chronic phases, highlighting economical advantages of closed method." } ] }, { "id": "pmid:10912023", "pmid": "10912023", "doi": null, "nctId": null, "pmcid": null, "title": "[The radical treatment of a suppurating epithelial coccygeal cyst and of a cyst of the sacrococcygeal area]", "firstAuthor": "Chupryna", "multipleAuthors": true, "journal": "Klin Khir (1962)", "year": 1993, "design": "case-series", "n": 65, "nField": "reported", "population": "patients with infected pilonidal sinus and cyst in the sacro-coccygeal region", "intervention": "radical excision of the cyst followed by helium-neon laser irradiation of the wound", "comparator": "none stated", "primaryOutcome": "wound outcome after treatment", "result": "abstract does not report specific outcome data or statistics", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "small uncontrolled case series with no comparison group and no detailed outcome data reported.", "directness": "direct", "limitations": "no control group, no quantitative results given, very brief abstract", "followUp": "", "plainFinding": "No clear result reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/10912023/", "sourceText": "The results of treatment of 65 patients after radical excision of the suppurated pilonidal sinus and cyst of the sacro-coccygeal region with subsequent irradiation of the wound with scattered beam of the helium-neon laser are presented.", "provenance": [ { "field": "n", "quote": "The results of treatment of 65 patients" }, { "field": "population", "quote": "suppurated pilonidal sinus and cyst of the sacro-coccygeal region" }, { "field": "intervention", "quote": "radical excision of the suppurated pilonidal sinus and cyst of the sacro-coccygeal region with subsequent irradiation of the wound with scattered beam of the helium-neon laser" }, { "field": "comparator", "quote": "The results of treatment of 65 patients after radical excision of the suppurated pilonidal sinus and cyst of the sacro-coccygeal region with subsequent irradiation of the wound with scattered beam of the helium-neon laser are presented." }, { "field": "primaryOutcome", "quote": "are presented" }, { "field": "result", "quote": "are presented" } ] }, { "id": "pmid:10912022", "pmid": "10912022", "doi": null, "nctId": null, "pmcid": null, "title": "[The use of a laser in the surgical treatment of an epithelial coccygeal cyst]", "firstAuthor": "Grubnik", "multipleAuthors": true, "journal": "Klin Khir (1962)", "year": 1993, "design": "case-series", "n": 31, "nField": "reported", "population": "patients with pilonidal (epithelial coccygeal) cyst, including acute and chronic inflammation and complicated cases with fistulas", "intervention": "laser scalpel (CO2 laser) surgery for pilonidal sinus, including a technique for plastic wound closure using laser photohydraulic preparation", "comparator": "conventional surgical treatment methods", "primaryOutcome": "postoperative complications (suppuration, pain, wound swelling), disease recurrence, and scarring", "result": "Laser treatment reduced postoperative suppuration and pain in acute cases, showed no difference from conventional methods in uncomplicated chronic cases, and in complicated cases treated with the new technique no recurrence or scarring was noted", "resultDirection": "mixed", "quality": "very-low", "qualityWhy": "This is a small, non-randomized case series with vague reporting, so it cannot reliably show whether laser treatment truly works better.", "directness": "direct", "limitations": "No control group for the complicated-case technique, no randomization, small sample size, and no clear duration of follow-up stated.", "followUp": "", "plainFinding": "Fewer complications, no benefit in chronic cases.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/10912022/", "sourceText": "In acute inflammation of pilonidal sinus (PS), use of a laser scalpel permitted to reduce considerably the incidence of postoperative suppuration. Pain syndrome became less pronounced, or was absent, wound swelling disappeared at the early period. No differences in results of surgical treatment of uncomplicated PS at the stage of chronic inflammation in use of CO2-laser and conventional methods of treatment were noted. An original technique of operation for PS complicated by multiple fistulas, purulent leaks, pyodermia has been suggested. For plastic closure of a wound, the effect of laser photohydraulic preparation was used. Operated on was 31 patient, no disease recurrence was noted. Rough cicatricial deformity of the sacro-coccygeal region was absent.", "provenance": [ { "field": "population", "quote": "In acute inflammation of pilonidal sinus (PS)" }, { "field": "population", "quote": "uncomplicated PS at the stage of chronic inflammation" }, { "field": "population", "quote": "PS complicated by multiple fistulas, purulent leaks, pyodermia" }, { "field": "intervention", "quote": "use of a laser scalpel" }, { "field": "intervention", "quote": "For plastic closure of a wound, the effect of laser photohydraulic preparation was used" }, { "field": "comparator", "quote": "conventional methods of treatment" }, { "field": "primaryOutcome", "quote": "reduce considerably the incidence of postoperative suppuration" }, { "field": "primaryOutcome", "quote": "Pain syndrome became less pronounced, or was absent, wound swelling disappeared at the early period" }, { "field": "primaryOutcome", "quote": "no disease recurrence was noted" }, { "field": "result", "quote": "permitted to reduce considerably the incidence of postoperative suppuration" }, { "field": "result", "quote": "No differences in results of surgical treatment of uncomplicated PS at the stage of chronic inflammation in use of CO2-laser and conventional methods of treatment were noted" }, { "field": "result", "quote": "Operated on was 31 patient, no disease recurrence was noted" }, { "field": "n", "quote": "Operated on was 31 patient" } ] }, { "id": "pmid:10160877", "pmid": "10160877", "doi": null, "nctId": null, "pmcid": null, "title": "The use of the CO2 laser in pilonidal sinus disease: preliminary results of an ambulatory prospective study", "firstAuthor": "Klin", "multipleAuthors": true, "journal": "J Clin Laser Med Surg", "year": 1990, "design": "case-series", "n": 70, "nField": "reported", "population": "young adults (mostly young men, median age 19) with pilonidal sinus disease treated as outpatients", "intervention": "surgery (incision/drainage or excision) plus CO2 laser therapy, curettage, and peroxide irrigation", "comparator": "none - single group case series", "primaryOutcome": "healing time, complications, and recurrence of pilonidal sinus", "result": "most wounds healed within 4 weeks, complications were minor, and only 4.3% had major recurrence", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this was a small uncontrolled case series with no comparison group, so it cannot show whether laser added any benefit over standard treatment.", "directness": "direct", "limitations": "no control group, not randomized, described as 'preliminary results', and outcomes were not compared to a non-laser treatment arm.", "followUp": "", "plainFinding": "Mostly healed within 4 weeks", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/10160877/", "sourceText": "During a period of 18 months, from January 1988 to June 1989, 70 patients were treated for pilonidal sinus disease in a Multi-Specialty Military Clinic. There were 62 men and 8 women, with a median age of 19 years (range 18 to 35). All were managed as outpatients under local anesthesia. When an abscess was involved, the surgical procedure included incision, drainage, curettage, peroxide irrigation, and CO2 laser therapy. For the other processes, the surgical procedure included excision of sinus tissue and lateral fistulas, curettage, peroxide irrigation, and CO2 laser therapy with secondary healing. Morbidity was minimal. Healing time ranged from 14 days to 8 weeks, yet most sinuses healed in 4 weeks. The complications observed--pain, bleeding, and skin bridging--were minor. All recurrences but three were minor and healed completely after additional local treatment (4.3 percent major recurrences). Preliminary satisfactory results are reported, supporting a more conservative approach in the treatment of this often overtreated disease.", "provenance": [ { "field": "n", "quote": "70 patients were treated for pilonidal sinus disease" }, { "field": "population", "quote": "There were 62 men and 8 women, with a median age of 19 years (range 18 to 35)." }, { "field": "intervention", "quote": "the surgical procedure included excision of sinus tissue and lateral fistulas, curettage, peroxide irrigation, and CO2 laser therapy with secondary healing" }, { "field": "comparator", "quote": "All were managed as outpatients under local anesthesia." }, { "field": "primaryOutcome", "quote": "Healing time ranged from 14 days to 8 weeks, yet most sinuses healed in 4 weeks." }, { "field": "result", "quote": "All recurrences but three were minor and healed completely after additional local treatment (4.3 percent major recurrences)." }, { "field": "qualityWhy", "quote": "Preliminary satisfactory results are reported, supporting a more conservative approach in the treatment of this often overtreated disease." } ] }, { "id": "pmid:2515648", "pmid": "2515648", "doi": null, "nctId": null, "pmcid": null, "title": "[Carbon dioxide laser in the surgical treatment of proctologic diseases]", "firstAuthor": "Skobelkin", "multipleAuthors": true, "journal": "Vestn Khir Im I I Grek", "year": 1989, "design": "case-series", "n": 556, "nField": "reported", "population": "adults with various anorectal (proctologic) diseases", "intervention": "CO2 laser surgery for anorectal conditions", "comparator": "not explicitly stated, implied comparison to standard surgical treatment", "primaryOutcome": "surgical outcomes including complications, recurrence rate, and recovery time", "result": "Fewer complications, half as many recurrences, and shorter hospital and recovery time with CO2 laser surgery", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is an old case series mixing many different anorectal diseases with no clear control group or statistical testing, so it can't reliably show the laser works for pilonidal cysts specifically.", "directness": "indirect", "limitations": "No randomization, no defined comparator group, mixed diagnoses lumped together, and pilonidal cysts not singled out as a specific outcome.", "followUp": "", "plainFinding": "Fewer complications, faster healing overall", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/2515648/", "sourceText": "Results of the surgical treatment of 556 patients with different diseases of the anorectal area with the help of CO2 laser are presented. Functional results were good, the amount of postoperative complications was 1.5 times less, recurrences were half less, the time of intrahospital treatment was 1.5 day shorter, the period of ambulatory rehabilitation 3.8 days shorter.", "provenance": [ { "field": "n", "quote": "Results of the surgical treatment of 556 patients with different diseases of the anorectal area with the help of CO2 laser are presented." }, { "field": "population", "quote": "patients with different diseases of the anorectal area" }, { "field": "intervention", "quote": "CO2 laser" }, { "field": "comparator", "quote": "the amount of postoperative complications was 1.5 times less" }, { "field": "primaryOutcome", "quote": "Functional results were good, the amount of postoperative complications was 1.5 times less, recurrences were half less, the time of intrahospital treatment was 1.5 day shorter, the period of ambulatory rehabilitation 3.8 days shorter." }, { "field": "result", "quote": "recurrences were half less, the time of intrahospital treatment was 1.5 day shorter, the period of ambulatory rehabilitation 3.8 days shorter" } ] } ], "faqs": [ { "q": "How is laser ablation used for pilonidal sinus?", "a": "In these studies, a thin laser fiber is passed into the sinus tract (the tunnel under the skin) and used to seal it shut from the inside. It's usually done under local anesthesia as an outpatient procedure, often in under 30 minutes." }, { "q": "Does laser hair removal help with pilonidal cysts?", "a": "The evidence is mixed. One trial of 302 people found that adding laser hair removal to standard care lowered the chance of the cyst coming back. But another trial of 60 people found the opposite — more cysts returned when laser hair removal was added to surgery. There isn't a clear answer yet." }, { "q": "Is laser treatment for pilonidal cysts available in Melbourne or near me?", "a": "This review summarizes what the research found about whether the treatment works, not where to get it. None of the studies looked at availability by location. Ask a local colorectal surgeon or dermatologist whether they offer sinus laser treatment or laser hair removal for this condition." }, { "q": "Should I stop laser hair removal if I'm using it for my pilonidal cyst?", "a": "Not necessarily, but don't assume it will prevent a recurrence. One well-run trial found it was linked to more cysts coming back when combined with surgery, while another found the opposite. Talk to your surgeon about what the evidence shows before relying on it alone." }, { "q": "What should I do instead of laser treatment?", "a": "Talk with a colorectal surgeon about conventional surgical options, such as flap surgery, which have been studied for longer with more consistent results. Laser treatment may still be reasonable in some cases, but current evidence doesn't show it's clearly better or safer than standard surgery." } ], "searchedAs": [ "pilonidal cyst laser treatment", "how is laser ablation used for pilonidal sinus", "laser ablation pilonidal cyst", "laser hair removal for pilonidal cysts", "laser treatment for pilonidal sinus", "pilonidal cyst laser", "laser hair removal for pilonidal sinus", "pilonidal cyst laser treatment melbourne" ], "patientTakeaway": "The research on laser treatment for pilonidal cysts is mixed, and one well-conducted trial found that adding laser hair removal to surgery was linked to more cysts coming back, not fewer. Don't assume laser treatment will lower your chance of recurrence just because it sounds less invasive. Talk to a colorectal surgeon about proven surgical options and ask what the evidence shows for the specific procedure they're recommending.", "methodology": { "databases": [ "PubMed", "ClinicalTrials.gov", "Crossref" ], "searchStrings": { "pubmed": "(\"Pilonidal Sinus\"[Mesh] OR pilonidal cyst[tiab] OR pilonidal sinus[tiab]) AND (laser[tiab] OR \"Laser Therapy\"[Mesh] OR \"Low-Level Light Therapy\"[Mesh] OR laser ablation[tiab] OR laser hair removal[tiab] OR SiLaT[tiab])" }, "pubmedQueryTranslation": "(\"Pilonidal Sinus\"[MeSH Terms] OR \"pilonidal cyst\"[Title/Abstract] OR \"Pilonidal Sinus\"[Title/Abstract]) AND (\"laser\"[Title/Abstract] OR \"Laser Therapy\"[MeSH Terms] OR \"Low-Level Light Therapy\"[MeSH Terms] OR \"laser ablation\"[Title/Abstract] OR \"laser hair removal\"[Title/Abstract] OR \"SiLaT\"[Title/Abstract])", "searchedOn": "2026-10-13", "inclusion": [ "Human, animal or laboratory studies reporting an outcome relevant to the question" ], "exclusion": [ "Records about a different condition or intervention", "Records reporting no outcome", "Retracted publications, which are listed but excluded from every count" ], "extractionLevel": "abstract", "gradingNote": "Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.", "limits": [ "Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured." ] }, "seo": { "title": "Does Laser Treatment Work for Pilonidal Cysts?", "description": "Research on laser treatment for pilonidal cysts is mixed: 11 randomized trials disagree, and one well-run trial found higher recurrence." }, "lastChecked": "2026-10-13", "lastChanged": "2026-10-13", "nextCheckDue": "2026-11-13", "history": [], "pipeline": { "screenModel": "claude-haiku-4-5", "extractModel": "claude-sonnet-5", "composeModel": "claude-sonnet-5", "promptVersion": "ev-1", "ranOn": "2026-10-13" }, "status": "published" }