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

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. 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. 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. 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.