Sacrococcygeal pilonidal disease (SPD) is a chronic inflammatory condition characterized by sinus tract formation in the natal cleft, predominantly affecting young adults and males [1]. The disease is believed to arise from hair penetration into the subcutaneous tissue, leading to a foreign body reaction and chronic infection [2]. SPD causes pain, discharge, recurrent abscesses, and significant impairment of quality of life. Numerous surgical techniques have been described for the management of SPD, including wide excision with secondary healing, primary closure, and various flap procedures [3]. Although excision is effective, it is frequently associated with prolonged wound healing, postoperative pain, extended hospital stay, and delayed return to work [4]. Minimally invasive techniques have gained attention in recent years to reduce surgical trauma while maintaining disease control. Laser therapy ablates the sinus tract epithelium and hair follicles using thermal energy, resulting in obliteration of the tract with minimal collateral tissue damage [5,6]. Early studies have reported reduced postoperative pain and faster recovery with laser-based approaches. However, comparative prospective data between laser therapy and conventional excision remain limited, particularly from Indian clinical settings [7]. This study was therefore undertaken to prospectively compare the outcomes of laser therapy and excision in patients with sacrococcygeal pilonidal disease.

This prospective comparative study was conducted in the Department of General Surgery at Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, after obtaining Institutional Ethics Committee approval and written informed consent from all participants. Patients aged ≥18 years with clinically diagnosed primary sacrococcygeal pilonidal disease were included. Patients with recurrent disease, acute pilonidal abscess requiring emergency drainage, associated anorectal pathology, or significant comorbidities affecting wound healing were excluded. Thirty-six eligible patients were allocated into two groups: laser therapy (n = 18) and conventional excision (n = 18). Laser therapy was performed using a diode laser following sinus tract curettage and hair removal. Conventional excision involved complete excision of the sinus tract, with wound management as per institutional protocol. All patients received standardized perioperative care and were followed up for six months. Postoperative outcomes assessed included pain using the visual analog scale, duration of hospital stay, time to complete wound healing, time to return to work, postoperative complications, and recurrence. Statistical Analysis Data were analyzed using IBM SPSS Statistics software. Continuous variables were expressed descriptively, and categorical variables were compared using the chi-square test or Fisher’s exact test. A p-value <0.05 was considered statistically significant.

Thirty-six patients were included, with equal distribution between laser and excision groups. Baseline characteristics were comparable. Table 1. Study Population Demographics Variable Category Frequency Percent (%) Gender Male 22 61.1 Female 14 38.9 Age 20-25 years 19 52.8 26-30 years 17 47.2 Average Sitting Hours 5-7 hours 18 50.0 8-10 hours 17 47.2 More than 10 hours 1 2.8 Distribution of Pits Midline 23 63.9 Lateral 13 36.1 The study population was male predominant, with males accounting for 61.1% of cases. Most patients were young adults, with over half (52.8%) belonging to the 20–25-year age group. Prolonged sitting was common, with nearly half of participants reporting an average sitting duration of 8–10 hours per day. Midline pits were more frequently observed than lateral pits, accounting for 63.9% of cases. Table 2. Comparison of Postoperative Outcomes Outcome Laser Therapy Excision Significance Postoperative pain 2.06 5.50 <0.001 Cosmetic satisdaction 4.56 2.50 <0.001 Wound healing time 4.06 8.50 <0.001 Return to work 6.50 days 14.17 days <0.001 Patients treated with laser therapy experienced significantly lower postoperative pain scores and higher cosmetic satisfaction compared with those undergoing excision. Laser therapy was also associated with faster wound healing and a significantly earlier return to work. All observed differences between the two groups were statistically significant (p < 0.001). Table 3. Recurrence Rates Recurrence Laser Excision p-value No 15(83.8%) 18(100%) 0.70 Yes 3(16.7%) 0(0%) Total 18(100%) 18(100%) Laser therapy demonstrated superior short-term recovery outcomes. Although recurrence was higher in the laser group, the difference was not statistically significant. Figure 1. Pit Distribution among the groups (Laser -A; Excision – B) Figure 2. Comparison of postoperative pain scores between patients treated with laser therapy (A) and conventional excision (B).

This prospective comparative study evaluated outcomes of laser therapy versus conventional excision in the management of sacrococcygeal pilonidal disease. The findings demonstrate that laser therapy offers clear advantages in short-term postoperative recovery, including reduced pain, faster wound healing, shorter hospital stay, and earlier return to work, while maintaining comparable recurrence rates. Baseline demographic characteristics were comparable between the two groups, minimizing confounding influences on outcome assessment. The demographic profile of young adults affected by pilonidal disease observed in this study is consistent with the epidemiological patterns reported by Rajasekharan et al. [1] and Mahdy [8], who reported a peak incidence in the second and third decades of life. The etiopathogenesis involving hair penetration and chronic inflammation, as proposed by Karydakis [2], provides the biological rationale for minimally invasive hair-destruction techniques such as laser therapy. Postoperative pain was significantly lower in patients treated with laser therapy. This observation aligns with findings reported by Dessily et al. [6], who demonstrated minimal postoperative discomfort following radial laser probe ablation due to limited tissue trauma. Milone et al. [9] and Alferink et al. [10] similarly reported reduced pain scores and improved postoperative comfort with minimally invasive and laser-based approaches compared with wide excision. In contrast, conventional excisional techniques have been associated with higher pain burden and delayed recovery, as documented in systematic reviews by Mahmood et al. [3] and McCallum et al. [4]. Hospital stay and wound healing time were significantly shorter in the laser therapy group. Emile et al. [11] demonstrated faster epithelialization and reduced inpatient duration with minimally invasive techniques compared with excisional surgery. Tyrväinen et al. [12] also reported shorter healing times with laser ablation. Conversely, Stauffer et al. [13] reported prolonged wound care requirements and delayed healing following conventional excision and flap-based procedures. Return to work is a clinically relevant functional outcome, particularly in young and economically active patients. In the present study, return to work was significantly earlier in the laser group. Li et al. [14] reported similar findings, with rapid return to work following radial diode laser ablation. Milone et al. [9] and Gülen and Emral [15] also emphasized improved functional recovery and earlier social reintegration with minimally invasive approaches. In contrast, prolonged work absenteeism following excisional surgery has been consistently reported [8]. Postoperative complications were fewer in the laser group, reflecting reduced surgical trauma and smaller wound surfaces. Algazar et al. [16] demonstrated lower wound-related complication rates with laser therapy compared with excision. Meinero and Mori [5] emphasized that meticulous sinus tract preparation, hair removal, and complete ablation are critical technical factors influencing postoperative outcomes in minimally invasive pilonidal procedures. Recurrence was observed in a small proportion of patients treated with laser therapy, while no recurrence occurred in the excision group; however, this difference was not statistically significant. Comparable recurrence rates with minimally invasive techniques have been reported by Alferink et al. [10] and Tyrväinen et al. [12]. In contrast, Stauffer et al. [13] and Mahdy [8] reported lower recurrence rates with flap-based excisional procedures, underscoring the long-term durability of these procedures. The slightly higher recurrence observed with laser therapy may be attributable to incomplete obliteration of the sinus tract, highlighting the importance of careful patient selection and technical precision. Lifestyle and local factors also contribute to recurrence irrespective of surgical technique. Sievert et al. [18] identified obesity, sedentary lifestyle, and inadequate local hygiene as contributors to recurrence, reinforcing the need for structured postoperative counseling and preventive measures alongside surgical treatment. The limitations of this study include its single-center design and relatively short follow-up period, which may underestimate late recurrences. Larger multicenter studies with longer follow-up are required to define long-term outcomes further and refine selection criteria for laser therapy.

Laser therapy represents a safe and effective minimally invasive alternative to conventional excision for the management of sacrococcygeal pilonidal disease. In this prospective comparative study, laser therapy was associated with significantly reduced postoperative pain, shorter hospital stay, faster wound healing, and earlier return to work when compared with excisional surgery. Although recurrence was observed more frequently in the laser group, the difference was not statistically significant, and the overall clinical outcomes favored laser treatment in terms of patient comfort and functional recovery. Laser therapy may therefore be considered a patient-friendly option, particularly in young and working individuals who prioritize rapid rehabilitation. Larger multicentric studies with longer follow-up are required to define long-term recurrence patterns further and optimize patient selection criteria.

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