Efficacy and safety of laser ablation for recurrent pilonidal sinus: a systematic review and meta‑analysis.

Background: Recurrence remains a significant challenge following the surgical treatment of sacrococcygeal pilonidal sinus. Unlike patients with primary pilonidal sinus, those with recurrent cases often present with more complex sinus tracts, and scarring from previous surgeries increases the complexity of subsequent procedures. Therefore, selecting the appropriate surgical method for patients with recurrent pilonidal sinus requires greater caution. It is essential to reassess these patients to determine whether surgical techniques suitable for primary pilonidal sinus are equally effective for recurrent cases. Laser ablation, an innovative and minimally invasive technique, has emerged as a promising option for managing pilonidal sinus. This procedure uses a circular laser at the tip of a catheter to deliver energy, effectively destroying and ablating the sinus tract while promoting its closure. Previous studies have demonstrated the safety and efficacy of laser ablation in treating primary pilonidal sinus. The objective of this systematic review and meta-analysis is to assess the efficacy and safety of laser ablation in the management of recurrent pilonidal sinus.

Methods: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was carried out using PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov. Additionally, the references of all retrieved studies were screened to identify further eligible data. The search included studies published up to June 11, 2024. The primary outcome measure was the healing rate after laser ablation, which served as the metric for evaluating the efficacy of this technique in treating recurrent pilonidal sinus. Secondary outcome measures included the incidence of severe postoperative complications, which were assessed to determine the safety profile of laser ablation. According to the Clavien-Dindo classification of postoperative complications, we define severe complications as those classified as grade IIIb or higher.

Result: A total of seven studies were included in this meta-analysis. With the exception of one study published in 2018, the remaining six were published within the past 3 years. Two studies originated from Middle Eastern countries, while the other five were from European countries. In total, 137 patients with recurrent pilonidal sinus were included, of whom 112 achieved healing following laser ablation treatment. The pooled healing rate across these studies was 81.9% (95% CI, 65.4-94.6%; I² = 69.12%; p < 0.01). A subgroup analysis based on follow-up duration was also performed. The pooled healing rate for studies with a follow-up period of 12 months or less was 87.2% (95% CI, 63.2-100%; I² = 78.57%; p < 0.01), while for studies with a follow-up duration exceeding 12 months, the pooled healing rate was 74.5% (95% CI, 51.5-92.7%; I² = 47.48%; p = 0.15). In addition, five studies performed pit picking before laser ablation, while two studies did not. We conducted a subgroup analysis based on whether pit picking was performed before laser ablation. The results of the subgroup analysis indicated that the difference in efficacy between combined pit picking and laser ablation alone was not statistically significant (random effects model, p = 0.75). This suggests that both treatment methods may have similar effectiveness in the management of recurrent pilonidal sinus disease.

Conclusions: This meta-analysis demonstrates that laser ablation is an effective and safe method for the treatment of recurrent sacrococcygeal pilonidal sinus in the short term. However, the findings indicate a trend toward a lower healing rate with extended follow-up periods. To better assess the long-term efficacy of laser ablation in managing recurrent pilonidal sinus, high-quality randomized controlled trials with extended follow-up durations are necessary.