Ultrasound-guided versus conventional sinus tract laser closure for adolescent sacrococcygeal pilonidal disease: a retrospective comparative study

Abstract Background Sacrococcygeal pilonidal disease (SPD) is common in adolescents and often recurs after surgery. Sinus tract laser closure (SiLaC) helps with healing, reduces recurrence, and improves appearance but may miss sinus branches. Using ultrasound guidance during SiLaC ensures precise treatment and protects healthy tissue. This study compared the short- and medium-term efficacy of ultrasound (US)-guided SiLaC with conventional SiLaC in treating adolescent patients with SPD. Methods This retrospective study gathered and analyzed clinical data from 64 adolescent (18 years or younger) patients with SPD who underwent either SiLaC or US-guided SiLaC at a single center from March 2021 to January 2025. The study included 38 patients who received conventional SiLaC and 26 patients who received US-guided SiLaC, and recorded demographics, surgical history, lifestyle factors, laser parameters, short-term complications, healing and recurrence rates, wound closure time, and recovery time. Results Among the 64 patients, 89.1% were male and 10.9% female, with a median age of 17 years. The US-guided group had a median follow-up of 18.0 (8.0, 37.8) months, while the conventional group had 20.5 (9.5, 35.8) months, both groups with similar demographic characteristics. The US-guided group showed significantly lower intraoperative laser duration and energy use ( p < 0.05), and faster wound closure ( p = 0.017). Recurrence was 4% in the US group vs. 25% in the conventional group ( p = 0.037). No significant difference was found in the time to resume normal activities ( p = 0.091). Conclusions Preliminary results suggest that US-guided SiLaC enhances the precision of sinus tract ablation by providing real-time intraoperative visualization in adolescents with SPD. In this cohort, its application was associated with reduced recurrence rates and expedited wound healing. However, these findings necessitate validation through larger-scale studies.