Does laser treatment affect outcome in pilonidal sinus disease? Long-term multicenter retrospective analysis of pit-picking alone vs. pit-picking with laser

Objectives: The optimal management of pilonidal sinus disease (PSD) remains controversial, with multiple treatment approaches available. Pit-picking is a minimally invasive technique, often enhanced with laser treatment (LT), but the long-term benefits of LT remain uncertain. The objective of this study is to compare pit-picking alone versus pit-picking combined with LT. Methods: This is a multicenter retrospective cohort study including seven centers across Turkey. Patients who underwent pit-picking surgery for PSD between June 2017 and March 2025 were included. Patients receiving adjunctive treatments beyond LT, undergoing excisional procedures, or with incomplete follow-up data were excluded. Pit-picking surgeries performed with or without LT were compared. The primary measure was the recurrence rate at 5 years. Secondary outcomes were postoperative pain, time to complete healing, complications, return to work, and costs. Results: Of 306 patients, 109 (35.6%) underwent pit-picking alone, and 197 (64.4%) received pit-picking with LT. The complication rate was lower in the LT group (6.1% vs. 14.7%, p = 0.012). Patients treated with LT had shorter times to pain-free sitting (median 5 vs. 7 days, p < 0.001) and return to work (3 vs. 6 days, p < 0.001). Complete healing was achieved in 97.4% of patients, with a median time of 14 days. Recurrence rates at 5 years were similar (pit-picking: 13.8%, pit-picking + LT: 12.7%, p = 0.460). Costs were higher for the LT group ($1212 ± 146 vs. $888 ± 148), although complicated pit-picking cases had comparable costs to the LT group ($1198 ± 370, p = 0.004). Risk factors for recurrence included high BMI, family history, advanced Tezel stage, and postoperative complications. Conclusions: While LT improves early postoperative outcomes, it does not impact long-term recurrence rates. The increased cost of LT should be weighed against its benefits in reducing complications, pain, and recovery time. Further randomized trials are needed to refine patient selection criteria and assess cost-effectiveness.