P152 Pilonidal sinus disease: a carbon footprint cost analysis of current treatments

Abstract Pilonidal sinus disease (PSD) is a suppurative condition primarily affecting young adult men. Laser hair removal (LHR) is an established neoadjuvant or adjunct therapy to reduce recurrence. Surgical options for chronic PSD management include excision and lay open, closure or flap repair. In a subgroup of 32 out of 97 patients with PSD at a regional referral centre who underwent LHR without surgery, 75% (24 patients) experienced improvement or healing, with no recurrences reported. This suggests LHR may offer a curative option for early-stage disease by removing the hair shaft, a key factor in pathogenesis. The National Health Service (NHS), the first national health system to legislate net zero (Health and Care Act 2022), targets an 80% reduction by 2028–2032. While clinical need drives procedure selection, carbon-efficient approaches could provide broader systems and public benefits. In the short term, LHR offers a viable alternative to surgery with lower carbon and cost impacts. An average regimen of nine sessions with 20 min of laser use generates 168 g of CO2, equivalent to driving 1.05 km. Evaluating the carbon impact of medical procedures through frameworks like the Greenhouse Gas Protocol remains underexplored. However, Maheshwari et al. (2024) reported the average carbon footprint of a laser procedure in the UK at 3.14 kg, rising to 15 kg with patient and staff transport. In contrast, Tan et al. (2020) found that a 30-min dermatological excision in Australia generated 52.5 kg of CO2, reduced to 31.1 kg excluding transport. A significant source of surgical greenhouse gases is anaesthetic gases; a 45-min procedure with a 15-min induction can produce 800–1600 g of CO2 (equivalent to driving 5–10 km). Additionally, single-use surgical consumables contribute to the overall carbon footprint. MacNeill et al. (2017) found that the average surgical procedure generates 232 kg of CO2, excluding staff and patient transport. There is no national guidance or universally accepted staging system for PSD management. Patients selected for LHR generally present with less severe disease and are excluded if they have active infection. Conversely, patients with advanced disease and multidirectional extension will need surgical treatment. Evidence that indicates patients undergoing LHR, either alone or as adjunct to surgery, have lower recurrence rates than with surgery, particularly in early-stage disease. LHR presents an effective, lower-carbon alternative to surgery for selected patients with PSD. Prospective studies are needed to evaluate long-term outcome and recurrence rates, informing more sustainable care pathways and supporting NHS net zero goals.