Early postoperative outcomes of sinus laser closure versus crystallized phenol treatment for pilonidal sinus disease: a retrospective comparative study.

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.