DS25 A comparison of surgical intervention with adjunct laser hair removal against primary laser hair removal in pilonidal sinus disease: a post hoc analysis of a retrospective cohort study

Abstract Pilonidal sinus disease (PSD) is a chronic condition where current management is typically led by colorectal surgeons. Incision and drainage and excision of the affected areas are the most commonly performed procedures. Flaps and endoscopic interventions are less frequently used but increasingly performed. Laser hair removal (LHR) has become an effective adjunct to surgery, reducing recurrence and postsurgical interventions. This retrospective study evaluates 97 patients referred for LHR from 2017 to 2023. Patient demographics, PSD clinical stage, laser type, session count, surgical interventions and outcomes were analysed using Microsoft Excel and R. Treatment outcomes were categorized as improvement (healed or improved) or no improvement, with disease severity classified using the method of Guner et al. (Guner A, Cekic AB, Boz A et al. A proposed staging system for chronic symptomatic pilonidal sinus disease and results in patients treated with stage-based approach. BMC Surg 2016; 16: 18). The number of LHR sessions provided was the only predictive factor for symptom resolution (Kruskal–Wallis test: P < 0.001). A noninferiority analysis was performed to compare treatment outcomes in patients with surgical treatment with adjunct LHR, and those with laser treatment alone (laser relative risk = 1.18, Δrelative risk = 0.33, P < 0.001). Fisher’s exact test was used to compare baseline disease severity in these two groups (P = 0.06). There was no statistically significant association between treatment outcome and age, type of laser or disease severity (Kruskal–Wallis test). No complications were reported and there was only one case of PSD recurrence. No acute or chronic complications were reported. Transient mild side-effects of discomfort and redness were reported in a few patients but did not lead to treatment termination. Primary LHR appears to be noninferior to surgery with adjunct LHR. LHR removes the irritating hairs in the natal cleft allowing the sinuses, pits and inflammation associated with PSD to resolve without the need for further surgical intervention. In addition to usage as an adjunct to surgical treatment, there is a potential for laser hair depilation to be used as the sole curative treatment in early-stage PSD. Further comparative studies are needed analysing the effectiveness of laser hair depilation against current established treatment such as surgical management and phenol application.