Future of pilonidal cyst surgery: a comparative review of traditional and laser techniques

Pilonidal disease is a common sacrococcygeal cyst or sinus that can significantly impact patients' quality of life, necessitating an analysis of evolving treatments to optimize patient outcomes. This review compares traditional and minimally invasive techniques focusing on laser ablation, in treating pilonidal cysts, focusing on each method's effectiveness, recovery time, recurrence rates, complications, cosmetics, and costs. We conducted a comprehensive assessment of literature exploring PubMed, Scopus, Web of Science, Google Scholar, and Embase for studies comparing traditional surgical techniques including traditional excision with open and closed healing, flap reconstructions, with minimally invasive procedures focusing on laser-assisted. Although traditional surgical techniques were practical, but they were associated with a relatively high risk of wound complications, recurrence, extended healing periods, and poor cosmetics. Laser techniques showed promising results in reducing hospital stays (for at most 3 h vs. days), postoperative pain, and recurrence rates, with healing rates up to 97%. However, laser methods may be less effective in severe or complicated cases, and they have higher costs. Laser-assisted techniques offer a less invasive option compared to traditional surgery, with greater patient fulfillment. However, additional research is needed to optimize laser procedures, especially in complex cases, and to establish long-term outcomes. For simpler pilonidal cysts, laser treatments are a promising option that could eventually replace traditional surgery as the standard of care.