Nd:YAG and CO2 lasers for the treatment of pilonidal sinuses: Advantages over traditional techniques

Pilonidal disease is a common problem in countries with a hot climate. Prolonged healing time and high recurrence rate are the common problems encountered while treating the disease. We evaluated the outcome of surgery in patients whose pilonidal disease was operated using Nd:YAG or CO2 lasers and compared it to the outcome of conventional (non laser) surgery. During the last 9 years 300 patients were operated on in our institute for pilonidal disease. Except for the first 10 patients all patients were operated on under local anesthesia. The operating methods included: (1) Conventional cystectomy through paramedian incision. (2) Nd:YAG laser cystectomy through paramedian incision. (3) Conventional midline cystostomy and curettage. (4) Nd:YAG laser midline cystostomy and curettage, and (5) CO2 laser cystotomy and curettage through a midline incision. The groups were compared regarding bleeding, healing time, postoperative infection rate and recurrence rate. Operative time was similar. Results: Healing time was considerably shorter in all laser treated groups. The rate of postoperative bleeding, post-operative infections and recurrences was also lower in all these groups. The Nd:YAG laser and the CO2 laser yielded similar results. Healing time and postoperative complications were compared. Laser surgery is advantageous over the equivalent conventional surgery in the treatment of pilonidal disease. The main advantage is the much shorter healing time (wound closure) and simplicity of technique. Complication rate was also lower in the laser treated group. The Nd:YAG and the CO2 laser operative results are comparable. Better cost effectiveness is an advantage of the CO2 laser over the Nd:YAG laser.