Natal Cleft Research Articles

What primary care clinicians need to know about pilonidal disease.

Pilonidal disease, although relatively common, often is not appropriately recognized and treated. This inflammatory condition may be found in several areas on the body; this article reviews disease affecting the gluteal cleft, how to identify the condition, initial treatment, and when to consider surgical intervention for definitive care.

Lumbosacral Nevus Simplex in a Newborn Girl with an Asymmetrical Y-Shaped Gluteal Cleft

Lumbosacral Nevus Simplex in a Newborn Girl with an Asymmetrical Y-Shaped Gluteal Cleft

Modified Sinotomy with Marsuplization versus Excision with Lay Open in Treatment of Pilonidal Sinus Disease

Abstract Pilonidal sinus disease (PSD) is a common infection of the skin in the gluteal cleft, with a prevalence of 0.7% in the general population. Pilonidal sinus can occur in many different areas of the body but most are found in the sacrococcygeal area, in the natal cleft, approximately 5 cm from the anus. This is a prospective comparative randomized study conducted at Department of General Surgery, Imbaba General Hospital to compare the modified sinotomy with marsupialization versus excision with lay open in treatment of pilonidal sinus disease. Pre-study power analysis revealed that a sample size of 30 patients in each group would be sufficient with 80% power and a P value of 0.05. The perfect approach for the management of PNS should be simple, cause minimal pain, have best chance for success and least recurrence rate with low risk for complications, avoid general anesthesia, require minimal wound care, and ensure minimal inconvenience for the patient with rapid return to normal activity. Number of Patients participated in this study were n = 60 77% of the participants were males aged from 17-52 and 26.3 works as drivers. Operative time in modified sinotomy group ranged from 20-40 minutes and in lay open group ranged from 20-35 min (P-value: 0.07). Presence of hair in the back in the modified sinotomy group in 83.3% while in the lay open group 76.6% (P-value: 0.004). In conclusion, we believe that execution of a minimally invasive surgical technique for PSD can be among the most important methods for treating not only primary PSD but also complicated and recurrent PSD cases.

Chronic Diarrhea and Weight Loss in an 18-month-old Boy.

Chronic Diarrhea and Weight Loss in an 18-month-old Boy.

A Comparative Study on flap necrosis following Karydakis Flap Reconstruction and Z-Plasty in Patients with Sacrococcygeal Pilonidal Disease – Our experience

Aim: The purpose of this study was to evaluate patients with sacrococcygeal pilonidal sinus disease(SPSD) who underwent the Karydakis procedure and Z plasty at our centre concerning theperioperative findings, late postoperative results and recurrence. Patients and Methods: A total of30 patients presenting with SPSD at our centre underwent Karydakis flap repair and Z plasty fromMay 2019 to June 2021. These patients were then followed up and evaluated concerning operativetime, drain use, hospital stay, suture removal, complications, and recurrence. The adipocutaneousflap of Karydakis was devised to shift the natal cleft, while Z-plasty involves a fasciocutaneous flap.Results: The mean operative time was 60 min with a median hospital stay of 4 days. Drains wereremoved at a median of 5 days and sutures at a median of 15 days. The duration of hospitalisationfor the Karydakis procedure was found significantly lesser than that for Z-plasty Patients who werefollowed up for a median of 12 months. The overall complications were more in Z-plasty. Flapnecrosis developed in 30 % of the cases in the Z-plasty group, comparable to no recurrence seen inthe Karydakis procedure. Conclusion: Karydakis flap was found superior to Z-plasty, having lessseroma formation, no flap necrosis and no local hematoma Karydakis flap procedure is a relativelysimple procedure for SPSD and has advantages over Z-plasty technique like keeping scar away fromthe midline and flattening of the natal cleft, thus reducing local recurrence rates.

A Systematic Review of Fibrin Glue as an Ideal Treatment for the Pilonidal Disease.

Pilonidal sinus is an acquired condition caused by irritation to the hair follicles at the natal cleft, presenting with an abscess or chronic infection. It is prevalent in young adults affecting their productive lifestyle with morbidities. There are varieties of treatment options; however, there is no consensus yet for the ideal procedure. Less invasive procedures have evolved to replace the traditional surgical techniques, which cannot significantly reduce the risks of recurrence and wound complications despite extensive surgeries. We aimed to assess the effect of fibrin glue as a primary treatment after cleaning the sinus in pilonidal sinus disease. We searched for articles from PubMed®, Ovid MEDLINE®, Ovid EMBASE®, and Cochrane CENTRAL. Six studies that included 336 patients in total were analyzed. Fibrin glue treatment in these studies reported a quicker return to normal activities postoperatively, a low rate of infection, and an acceptable rate of recurrence. Thus, fibrin glue seems beneficial in the management of pilonidal disease. However, further high-quality studies are essential to support and confirm this evidence. Future research should also evaluate its cost and implications in the ambulatory service.

Evaluation of Different Methods of Treatment of Pilonidal Sinus; a Randomized Controlled Trial

Background: Sacrococcygeal Pilonidal disease is an infection of the skin and subcutaneous tissue at or near the upper part of the natal cleft of the buttocks. This results from chronic infection of hair follicles and subsequent formation of a subcutaneous abscess. Hair then enters the abscess cavity and provokes a foreign body tissue reaction with chronic suppuration and discharge. The aim of this study was the selection of best method of treatment of pilonidal sinus. Patients and methods: This randomized controlled trials was conducted on 56 patients with the diagnosis of pilonidal sinus disease were admitted to the Department of General Surgery, Zagazig University Hospitals from March 2020 to September 2020. The patients were allocated randomly into four groups, each included 14 patients; Group (1): was Conservative method with medical treatment and drainage if needed. Group (2): were operated by Open technique. Group (3): were operated by Limberg flap technique. Group (4): were operated by Karydakis technique. All patients were subjected to history taking, complete clinical examination, preoperative Laboratory investigations. Results: Recurrence was significantly associated with open and conservative groups while there was only one case in Limberg Group and no case in Karydakis Group. Conclusion: The Karydakis flap procedure should be chosen instead of the Limberg flap for treating uncomplicated Sacrococcygeal pilonidal disease because of its shorter operative time, earlier return to work, faster healing time and significantly higher patient satisfaction.

English

BACKGROUND Sacrococcygeal pilonidal sinus disease is defined as a hair-filled cavity in the subcutaneous fat of the natal cleft (postsacral intergluteal region). This study was done to investigate the prevalence, clinical presentation, body mass index (BMI) as a risk factor; and complications of Limberg flap and Z-plasty, for the reconstruction of defects after excision of sacrococcygeal pilonidal sinus in terms of the incidence of seroma, wound infection, wound dehiscence, flap necrosis, recurrence, duration of hospital stay and time taken for complete wound healing after the procedure. METHODS This was a prospective study done on 50 patients from January 2018 to October 2020 at a tertiary care hospital in 15 to 50 years of age group presenting with pilonidal sinus disease. Statistical analysis was done using SPSS (Statistical Package for Social Sciences) version 15.0 statistical analysis software. Significance was assessed at 5 %. RESULTS The mean age of presentation was 25 years with chief complains of swelling, discharge and pain, the mean BMI was 24.39 kg/m2 . Anaerobic infection is more common in the sinus (40 %), and among aerobic organisms, Staphylococcus was the most common organism (19 %). In Limberg flap closure, only one 1 developed wound infection and this same patient had partial wound dehiscence, while in Zplasty group, 3 developed seroma, 2 wound infections and 2 partial flap ischemia. CONCLUSIONS The goals of management of pilonidal sinus diseases include conservative management along with definitive surgical treatment of the disease. Pilonidal abscess is managed by incision and drainage and is followed by definitive treatment, later on. Flap procedures are effective ways to treat the disease, of which Limberg flap is the most reliable flap with minimum complications, lesser hospital stay and faster wound healing. KEYWORDS Pilonidal Sinus, Limberg Flap, Z-Plasty

Sacro-coxxygial hygiene, a key factor in the outcome of pilonidal sinus surgical treatment?

BackgroundSurgical wound infection contributes to prolonged recovery time after pilonidal sinus excision. As a standard procedure after surgery, we recommend our patients to perform water irrigations in the intergluteal cleft 4 to 6 times a day during the post-operative period. Our hypothesis is that this should reduce healing time and complication rates. The aim of this study was to measure the importance of sacro coccygeal hygiene in the management of pilonidal sinus disease.MethodsWe retrospectively collected data after surgical management of pilonidal sinus (sinusectomy procedures) in our division over a 10-year period. Patients were divided into three groups according to their local hygiene during postoperative follow-up and scored one (G1: good hygiene) to three (G3: poor hygiene). Primary outcome was complication rates. Secondary endpoints were, healing time, follow-up, time off work, and recurrence rate.ResultsIn G1 (N = 112), complication rate was 3.6%. In G2 (N = 109), it was 5.5%, whereas in G3 (N = 71), it reached 7.03%. However, there were no statistically significant differences between hygiene groups regarding complication rates in both univariate and multivariable analysis. Regarding secondary outcomes, there were significant differences between hygiene groups concerning median follow-up (p = 0.0001) and median time off work (p = 0.0127).ConclusionGood hygiene of wound is essential for optimal, rapid healing without complications. The importance of this report is to show that thanks to our hygiene follow-up strategy with frequent perineal irrigations and regular follow-up checks, patients with at a first glance “unclean local conditions”, reached similar complications, median healing time and recurrences rates to patients with medium and good wound hygiene level.

THE OUTCOME OF LIMBERG FLAP RECONSTRUCTION PROCEDURE FOR PRIMARY NATAL CLEFT PILONIDAL SINUS DISEASE: FOUR YEARS’ EXPERIENCE AT A TEACHING HOSPITAL IN PAKISTAN

Background: Natal cleft pilonidal sinus disease is known for its high recurrence rate after surgery. Different surgical procedures are being used for its treatment and these vary from wide excision followed by healing with secondary intention to excision followed by reconstruction with a flap. Limberg flap reconstruction procedure has been used by many surgeons as their primary choice owing to its low recurrence rate and less postoperative complications.
 Objective: The objective of this study was to assess the outcome of Limberg flap reconstruction procedure in patients with primary natal cleft pilonidal sinus disease. 
 Methods: This descriptive case series was conducted at Ghurki trust teaching hospital, Lahore, Pakistan, between January 2015 to December 2018. 110 consecutive patients with primary natal cleft pilonidal sinus disease were included in this study. Informed consent was taken from these patients and all patients underwent Limberg flap reconstruction procedure. The evaluated outcomes of this procedure included duration of hospital stay, postoperative pain, primary healing, surgical site Infection, seroma formation, flap necrosis and, recurrence. 
 Results: The patients age ranged between 18 years to 60 years. The mean age was 26.6 ±8.6 years. 73 patients (66.36 %) were males and 23 patients (33.63%) were females. The duration of disease ranged between 1 month to 6 months with a mean of 3.7±1.7 months. The mean operating time was 47.50±5.14 minutes. The mean duration of hospital stay was 1.87±0.80 days. The mean postoperative pain score calculated by the visual analogue scale (VAS) twenty-four hours after the surgery was 3.45. 95 patients (86.36%) had complete primary healing without any complication. 9 patients (8.18%) had a surgical site infection and 6 patients (5.45 %) had seroma formation. No patient suffered from flap necrosis. 2 patients (1.81%) who had complete primary healing presented with recurrence of the disease within six months of the procedure with a period of one year of follow-up designated for every patient.
 Conclusion: Limberg flap reconstruction procedure is a safe and efficacious treatment option for primary natal cleft pilonidal sinus disease because it provides early complete primary healing in most patients, and shortens the duration of hospital stay thus reducing the cost of treatment. The pain scores fall in the moderate post-operative pain score category and the complication rates and the recurrence rates are very low.

Outcome of Surgical Management of Sacrococcygeal Pilonidal Sinus Disease with Rotation Flap in 52 Patients-A Retrospective Study.

Background Surgical treatment of sacrococcygeal pilonidal sinus disease (SPSD) consists of radical excision of the entire tract and treatment of the resultant raw area. Here, the authors have reviewed the results of the rotation flap for closure of the SPSD. Aim This study aims to evaluate the outcomes following SPSD excision and rotation flap closure. Materials and Methods All patients were treated for SPSD with excision and closure using a rotation flap from January 2010 to September 2018. Cases having a follow-up of at least 6 months post surgery were evaluated. Result A total of 52 patients were included in the study; 42 cases were of primary disease while 10 were of recurrent disease. The patients’ follow-up records on the 3rd day, 10th day, 1 month, and 6 months were evaluated. None of the patients showed any signs of recurrence on follow-ups. One patient developed a hematoma on the third day post surgery which was treated conservatively. One patient developed a seroma in the perianal region on the fifth postoperative day which required aspiration. Both these patients healed well subsequently. Conclusion Rotation flap is a (simple and reliable) treatment option for closure of postexcision SPSD defect. It not only takes the tension away from suture line, but also pushes the gluteal fat from the sides into the midline, obliterating the deep crevice of the natal cleft which is believed to be one of the important factors in the causation of SPSD, thus minimizing recurrence.

Surgical Excision of a Pilonidal Sinus at the Neck Region

Pilonidal sinus (PNS) is a clinically diagnosed condition caused by hair entrapment underneath the skin leading to a granulomatous reaction and the formation of a tract. PNS is commonly found in the sacrococcygeal area (natal cleft). However, this is a rare case presentation of a male patient with PNS located at the back of his neck region as there were only four similar conditions reported in the literature review. The patient was first managed medically as a case of hidradenitis suppurativa by the dermatology department. Later on, when the treatment failed, he was treated surgically as a case of PNS with an excellent outcome. The patient was seen at the outpatient clinic one week after surgery. The wound was healed completely and totally recovered.

APPROACH TOWARDS SACROCOCCYGEAL FISTULA: A PROSPECTIVE CLINICAL AND COMPETITIVE INTERPRETATION

Background: Sacrococcygeal fistula, also known as Pilonidal sinus is an acute or chronic infection in the subcutaneous fatty tissue, mainly in the natal cleft. The condition, though not life threatening, is socially embarrassing and adversely affects the quality of life of patients. In Ayurvedic literature Sacrococcygeal fistula is better correlated and treated as Nadi Vrana. Acharya Sushruta had explained Para-surgical procedure with the intervention of medicated Seton (Kshara Sutra) as one of the treatment modalities. The ideal method of treatment of Sacrococcygeal fistula should be effective with a low recurrence rate, short hospital stay and economical.
 Aim: This study is an attempt to evaluate the efficacy of Arka Ksharasutra in the management of Sacrococcygeal fistula.
 Methodology: A total no. of 10 patients having signs and symptoms of Sacrococcygeal fistula were selected for Arka Ksharasutra ligation under local anesthesia and the Seton was changed every week during the entire treatment period.
 Results: In this study all the patients i.e.,100% were males with age between 25-35 years. The length of initial track was 3.6 to 5.5 cm and average Unit Cutting Time was 7.23 days/cm in previously non-operated cases and 11.26 days/cm in previously operated cases, average being 8.2days/cm. There was no post-operative complication and recurrence even after 3 months of follow-up.
 Conclusion: Arka Ksharasutra is laced with anti-bacterial, anti-fungal, bactericidal and anti- inflammatory properties which minimizes the use of antibiotics and also demolished the recurrence of symptoms.

Optimization of the Clinical Setting Using Numerical Simulations of the Electromagnetic Field in an Obese Patient Model for Deep Regional Hyperthermia of an 8 MHz Radiofrequency Capacitively Coupled Device in the Pelvis.

Simple SummarySeveral randomized controlled trials have shown that the concurrent use of hyperthermia with radiotherapy results in a significant increase in local control rates. However, in studies that analyzed thermal parameters, the radiosensitizing effect required a favorable increase in tumor temperature. A good temperature increase is more difficult to achieve in deep-seated tumors than in superficial tumors. In this study, the reduction of subcutaneous fat overheating, which is a weak point of the deep heating of a capacitively coupled heating system, and the optimization of temperature distribution in the deep regional hyperthermia in the pelvis were investigated using electromagnetic field numerical simulations. In conclusion, the use of overlay boluses, the salt solution concentration in the overlay boluses, and the intergluteal cleft bolus insertion were found to be important for optimizing the temperature distribution. Further studies with numerical simulations based on the patient’s body shape and tumor location are expected.Background: The purpose of this study was to evaluate the effectiveness of the clinical setting for deep regional hyperthermia of an 8 MHz radiofrequency (RF) capacitively coupled device in the pelvis by using numerical simulations of the electromagnetic field. Methods: A three-dimensional patient model of cervical cancer of the uterus in an obese patient was reconstructed with computed tomography data. The specific absorption rate (SAR) and temperature distributions among the various heating settings were evaluated using numerical simulations. Results: The averaged SAR value of the deep target tumor was similar between with or without overlay boluses (OBs), and that of the subcutaneous fat (SF) at the edges of cooling boluses with OBs was lower than that of the SF without OBs. The use of OBs reduced the overheating of the SF. The 0.5% salt solution in the OB produced the least overheated areas outside the deep target tumor compared with the other concentrations. The insertion of the intergluteal cleft (IGC) bolus could improve the temperature concentration of the deep target tumor. Conclusions: The use of OBs and the salt solution concentration in the OB were important to optimize the temperature distribution. IGC bolus might contribute to temperature optimization. Further studies with individualized numerical simulations in each patient are expected.

A COMPARATIVE CLINICAL STUDY OF ‘CHEDANA KARMA & KSHARSUTRA (SETON) KARMA’ (GUGGULU BASED) IN THE MANAGEMENT OF SHALYAJ NADI VRANA(SINUS) W.S.R. TO PILONIDAL SINUS (ASSOCIATED WITH ROPAN LEPA)

A Pilonidal Sinus is a common disease of the natal cleft. Pilonidal Sinus is a track which contains hairs. The incidence of the disease is calculated to be 26 per 100,000 people. Pilonidal disease has a male pre-dominance with a ratio of 3:1. There are several methods to treat pilonidal sinus, but the recurrence rate is more in modern surgical interventions. According to Ayurveda it can be correlated to Salyajanya Nadi Vrana (pilonidal sinus), a type of Nadi Vrana (sinus). Whose etiopathology is described in Nidanasthana and treatment aspect in Chikitsasthana of Susrutha Samhita. Susrutha mentioned the ap-plication of Kshara (caustic alkali) and Ksharsutra (Seton) (Seton) in the management of Nadi Vrana (si-nus). Studies show that by Ayurvedic treatment, it helps to reduce recurrence rate, even though Nadi Vrana (sinus) is said to be Kricchrasadhya (difficult to cure). Hence successful management of this disease de-pends on the knowledge of pathogenesis, patient’s presentation and knowledge on treatment aspects. In this Clinical study, effect of Chedana karma & Ksharsutra (Seton) karma’ (Guggulu based) in the management of Salyajanya Nadi Vrana (pilonidal sinus) w.s.r. To pilonidal sinus (associated with ropan lepa) is seen and conclusion in drawn.

The Bascom Cleft Lift as a Solution for All Presentations of Pilonidal Disease.

ObjectiveThis study is a report on 700 consecutive patients treated with the Bascom cleft lift as treatment for both simple and complex pilonidal diseases between 1993 and 2020.Patients and methodsThe Bascom cleft lift was used in patients with primary disease, recurrent disease, perianal disease, and failed flap procedures. Some technical modifications had to be made to accommodate patients with perianal disease, and they are described. All patients were treated by the author in private practice clinics and hospitals between 1993 and 2020 and were entered into a database concomitantly with their treatment. Patients were subsequently surveyed in preparation for this study, by phone, email, or email survey to determine the current status. The procedure consisted of excision of the sinus tracts, cysts, and open wounds; raising a skin and subcutaneous tissue flap; and flattening the gluteal cleft. Failure of the procedure was defined as lack of complete healing or recurrent pilonidal disease requiring revisional surgery. Complications were recorded and are described.ResultsWe found that of the 700 patients, 3.4% required revision of the cleft lift (confidence interval for proportion based on binomial distribution: 2.1%-4.8%). The median follow-up time for patients without recurrence was six months (IQR: 2-19.5). Once primary healing was obtained, there were no late recurrences in the 156 patients followed beyond 24 months. Factors that negatively impacted the success rate were having had previous failed pilonidal surgery (5.3% required revision) and open wounds on the edge of the anus (15.5% required revision).ConclusionsThe Bascom cleft lift had an overall success rate of 96.6%. There was no category of patients for which this was not a good option, but analysis of this data reveals that patients who have had previous failed surgery, and patients with wounds on the edge of the anus had a higher failure rate than the group as a whole.

Limberg Flap is a Safe and Effective Procedure for the Surgical Treatment of Pilonidal Sinus in Sacrococcygeal Region

Pilonidal sinus in the sacrococcygeal region is an acquired condition and usually seen in young male adults. Diagnosis is indicated by to see the site and appearance of chronic discharging opening, and identification of midline pit in the natal cleft. The management of the sacrococcygeal pilonidal sinus varies from clipping of hairs with good hygiene of the area, wide excision of the area with primary or secondary closure and newer flap procedures, but none is widely accepted. The main concern for the treatment to the patient is the recurrence. This prospective study has been performed to determine the effectiveness and safety of the Limberg flap procedure for sacrococcygeal pilonidal sinus for new and recurrent cases. Primary end point was rate of recurrence and secondary end points were its complianceand complications such as wound infection, postoperative pain and return to work. A total of 17 patients were operated from March 2012 to June 2016.Both primary and recurrent diseases were included. All patients successfully underwent surgery. Patients complained very minimal postoperative pain. LO were average 2 days. All patients were discharged with negative suction drain in situ. Drains were removed on 7th POD and stitches were removed on 9th to 12th postoperative day. All patients returned to work after 2nd weeks. In our study no recurrence or major complications were found. Limberg flap for sacrococcygeal pilonidal sinus was found very useful and effective in terms of recurrence rate and patients morbidity.
 J Shaheed Suhrawardy Med Coll, December 2020, Vol.12(1); 6-8

Limberg Flap Method for Pilonidal Sinus Disease

Sacrococcygeal pilonidal sinus disease is a common chronic inflammation of the natal cleft and is mainly seen in young adults. Authors of some earlier works regarded the condition as congenital. Recently, it has become widely accepted that the condition is acquired, and thought to originate from hair follicles. Many treatment options has described in literature, thus in this study we present our results with Limberg flap reconstruction on pilonidal sinus disease. 38 patients underwent limberg flap reconstruction for pilonidal sinus disease enrolled in this study. No bleeding has occur intra and postoperatively, 2 patients developed urinary retention (%5.2), on 1 patient with diabetes mellitus wound dehiscence has developed which has treated with 3 week long simple debridement method (%2.6). 1 patient developed superficial infection treated with basic antibiotics (%2.6). No other complications has developed. No recurrence has seen in -mean -11.2 month period. We think limberg flap closure on pilonidal sinus disease is an effective and safe option.

Z- Plasty: an Effective Technique for Pilonidal Sinus

Introduction: Pilonidal sinus is a commonly encountered problem with multiple surgical options. With Z- plasty, primary closure ensues faster healing while the alteration of local anatomy reduces recurrence. The extremely low recurrence rate following Z-plasty for pilonidal sinus results from the fact that the operation was planned with the true physiology of the disease in mind. It is the deep natal cleft which predisposes to pilonidal sinuses and this architecture is altered with multiple Z -plasty.
 Materials and methods: A prospective, observational study was conducted into department of Plastic Surgery and burn, Dhaka Medical College and Hospital. Here 18 patients with pilonidal sinus were treated by Z – plasty between 2013 to 2018.
 Result: There was only one recurrence during the follow up time. There were no necrosis of flaps and no wound dehiscence.
 Conclusion: The Z-plasty technique is an effective procedure for treating pilonidal sinus in terms of both faster healing and lower recurrence rate.
 J Dhaka Medical College, Vol. 28, No.2, October, 2019, Page 164-171

Study of laser treatment in primary pilonidal disease at a tertiary hospital

Background: Pilonidal sinus is a pathology that occurs with acute or chronic infection in the natal cleft, especially in young men. In order to decrease complications and recurrence rates after pilonidal sinus excision, it is desirable to use a less invasive technique that allows patients to recover more quickly and permanently. Present study was aimed to evaluate laser Pilonidotomy, a new technique for the treatment of pilonidal sinus. Material and Methods: Present study was a prospective, observational study conducted in ppatients diagnosed as cases of pilonidal sinus disease, attending surgical OPD, underwent laser pilonidotomy. Results: Total 32 patients were evaluated. Male patients (90.63%) were far more than female patients (9.38%). Mean duration of procedure was 30.34 ± 8.24 minutes, mean duration of hospital stay was 14.65 ± 7.13 hours. Most of patients resumed normal activity in 1.96 ± 0.81 days while complete wound healing by secondary intention was noted after 4.5 ± 1.2 weeks. Successful primary treatment was done in 90.63 %. Recurrence was noted in 3 patients (9.38 %). Infection (6.25 %) was noted in 2 patients, less common complications were bleeding (3.13 %), severe postoperative pain (3.13 %), hypertrophic scar (3.13 %). VAS score analysis was done and a significant change in VAS score was noted between day 1 and day 7. Conclusion: Laser treatment in primary pilonidal disease is minimal invasive surgery, is easy to perform with major advantages such as shorter hospital stay, less post-operative pain and care and the final aesthetic aspect.