Laser Ablation versus Simple Excision in the Treatment of Pilonidal Sinus Disease: A Prospective Comparative Study of Clinical Outcomes and Patient Satisfaction

Background: Pilonidal sinus disease (PSD) is a chronic inflammatory condition of the natal cleft affecting young adults. Conventional simple excision is widely practised but is associated with prolonged wound healing, postoperative pain and delayed return to activity. Laser ablation of the sinus tract is a minimally invasive alternative. Aims and Objective: To compare laser ablation and simple excision in PSD with respect to operative parameters, postoperative pain, wound healing, complications, recurrence, recovery time and patient satisfaction. Materials and Methods: This prospective, non-randomised comparative study was conducted in the Department of General Surgery, Maharani Laxmi Bai Medical College, Jhansi, from January 2025 to June 2026. Eighty patients aged 18–50 years with primary or recurrent PSD were allocated in a non-randomised manner to laser ablation (n=40) or simple excision (n=40) and followed for 6–12 months. The primary outcome was wound healing time; operative parameters, pain, complications, recurrence, return to activity and satisfaction were secondary outcomes. Outcomes were compared using the independent t-test and chi-square or Fisher's exact test. Results: The groups were comparable in age, sex and disease type. Laser ablation was associated with shorter operative time (27.93±5.47 vs 49.38±7.23 min), less blood loss (16.00±5.06 vs 67.38±14.04 ml), lower pain at 24 hours (VAS 2.65±0.80 vs 4.98±1.46), faster wound healing (18.85±4.25 vs 32.63±7.95 days) and earlier return to daily activities (7.38±1.88 vs 15.70±4.58 days) (all p<0.001). Overall complications were fewer (17.5% vs 45.0%; p=0.01). Recurrence was 5.0% versus 15.0% (p=0.26). Sixty percent of laser-treated patients were very satisfied compared with 25.0% after excision (p=0.006). Conclusion: Laser ablation is a safe and effective minimally invasive alternative to simple excision, offering faster recovery, lower morbidity and higher patient satisfaction with comparable short-term recurrence.