The outcomes of Laser versus Limberg flap for sacrococcygeal pilonidal sinus, meta-analysis study

The outcomes of Laser versus Limberg flap for sacrococcygeal pilonidal sinus, meta-analysis study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The outcomes of Laser versus Limberg flap for sacrococcygeal pilonidal sinus, meta-analysis study Alaa Alwadess, Samer AL-HAKKAK, Firas Al-masoody, Tamara Khadum, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6822266/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The introduction of laser treatment for sacrococcygeal pilonidal sinus has sparked debate about the most effective management approach. This study aims to summarize current evidence comparing the laser and Limberg flap techniques for treating this condition. Methods Databases including PubMed, Elsevier, Scopus, CINAHL, Google, and Springer were searched for studies comparing laser treatment to Limberg flap up to May 2025. PRISMA protocol was used .Data were collected for recurrence, operative time, infection, post-operative pain, healing, and the need for reoperation. JASP software and Meta-analysis online.com were used for statistical analysis. Missing data were addressed using imputation techniques. A p-value < 0.05 was considered statistically significant. Results Laser treatment was associated with significantly shorter operative times and less post-operative pain (p < 0.0001 for both). No significant differences were observed between laser and Limberg flap in recurrence, infection, healing time, or the need for additional operations (p value = 0.90, 0.26, 0.43, 0.17, respectively). Conclusion Laser application results in shorter operative times and reduced post-operative pain but shows no significant differences from the Limberg flap in recurrence, infection, healing, or need for further surgery. Laser Limberg flap Sacrococcygeal Pilonidal sinus Recurrence Meta-Analysis Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Introduction Laser therapy was first applied in pilonidal surgery and reported in 1990 1 . Since then, different applications of lasers in depilation have been developed to enhance outcomes and prevent recurrence of sacrococcygeal pilonidal sinus (PNS) 2–5 . Laser application has emerged as a comparable method of treatment, offering a shorter operative time, reduced pain, and easier application, but with a higher recurrence rate in some patients 6–9 . Laser development enables its use in the PNS tract ablation with variable success rates 6,10–12 . The aetiology of PNS disease is multifactorial, of obesity, long sitting, immune compromise status, hairy area and young age. The presentations of the PNS could be a spectrum of no symptoms to flare-ups of extensive infection and synergistic gangrene 13–15 . The laser effect is administered through the traditional technique after-curettage and irrigation. The laser treatment involves delivering an average energy of 320 joules using a 1470-nm diode laser (1 pulse: 6 s, 15 watts/1 pulse in 6 s = 90 joules) 16 . Different open techniques are in use to manage sacrococcygeal PNS. They include open flaps, complete primary closure, partial closure, and endoscopic closure 17,18 . Comparing lasers to conventional methods has been reported 6,7,9,19,20 . There have been different outcomes of laser and classic interventions. There was no meta-analysis (MA) or systematic review study comparing laser to Limberg flap(LF) in literature. This MA aims to report the current evidence of the outcomes of laser versus LF the in the sacrococcygeal PNS disease management. Methods This MA is based on studies that compare laser to LF. Three authors searched PubMed, Elsevier, Scopus, CINAHL, Google, and Springer platforms for studies that reported and compared laser to LF treatment up to May 2025.160 studies were found, but only five were comparing laser to the LF method and therefore selected 6,7,20 21,22 .PRISMA protocol was used 23 [see PRISMA flow chart,Fig. 7 ] .The studies period was 2022–2025. Full text of each study was available, and the data were collected for each parameter of recurrence, operative time, infection, post-operative pain, healing and the need for a new operation. The laser studies data were marked as an experimental technique, and the LF as a control group in all analyses and the six Forest plot figures. JASP software and meta-analysisonline.com statistics were used for analysing the data. The missing data were curated using the imputation technique to enhance reliability, reproducibility and facilitate sharing and use. Six forest plots were produced [Fig. 1 – 6 ]. The quality of the studies was assessed using Newcastle-Ottawa protocol [ see Table 1]. Results Figures 1 – 6 show the results of this meta-analysis. There was no significant difference in recurrence after laser or LF [P value was 0.90, heterogeneity was high (52.4%), which may indicate that a significant effect happened because of non-random chance [see Fig. 1 ]. There was a significant difference in operative time, laser is associated with shorter operative time compared to LF (P value was < 0.0001); however, the outcome is also associated with high heterogeneity(I 2 = 95.3%) [see Fig. 2 ]. There was no significant difference in infection rate between the two techniques, P value was 0.26, and the effect is randomly distributed as heterogeneity was zero [ see Fig. 3 ]. There was significantly less pain in the laser group, p value < 0.0001[see Fig. 4 ]. I 2 test = 0, indicated no heterogeneity. There was no difference in healing time (days), p value was 0.43, while heterogeneity was 0 for postoperative pain but very high for healing time at 87.8% [ see Fig. 5 ]. The laser group did not show a significant difference in the need for new operations compared to LF, p value was 0.17, with 3.1% heterogeneity. The majority of events were likely occurred because of random chance [see Fig. 6 ]. Discussion The most important findings of this analysis are shorter operative time, less pain in laser group and no significant difference in recurrence rate after Laser or LF technique, p value < 0.0001, 0.90 respectively. Significant heterogeneity of the analysis for the recurrence may suggest inconsistent effects in magnitude or direction. The I 2 test indicates that 52.4% of the variability among studies arises from heterogeneity rather than random chance. In addition to the included 5 studies in this MA ,most of the important laser studies confirmed no difference in recurrence using laser or other open methods 7,9,24,25 . Our analysis also showed the laser group enjoyed shorter operative times compared to the LF technique. There was greater heterogeneity of 95.3%, which means the variability is unlikely to happen by random chance, nevertheless, the laser technique is associated with a shorter time because of no time was spent on excision of tissues or creation a flap 26,27,9 . There was no significant difference in the infection rate, all patients were elective cases with no evidence of active infection at the time of operation. Preoperative presence of such infection was confirmed as a risk factor for recurrence 28 . Both techniques were conducted under aseptic conditions. Any immune-compromised status has the potential to influence the infection rate. Post-operative pain score was significantly different for Laser or LF patients, P value < 0.0001. In Algazar’s 7 and Chitrambalam’s studies 21 it was significantly less in the Laser group. The other three studies 6,21,22 did not include the pain score data, and data curation was done. Although the I 2 did not show any significant heterogeneity, however the finding should be cautiously interpreted taking in consideration the size of each study compared to the Tyrvainen 20 and Alwadess 6 cohorts. There was no significant difference in healing between the two techniques. Healing depends on several factors, including patient factors, surgery types, nutrition, connective tissue collagen, presence of infection or complications of bleeding, excessive and recurrent tissue trauma or ischemia 29–34 . There was no significant difference in the need for a new operation between the two groups. This was clear and expected, as there was no significant difference in the recurrence and healing. Limitations This meta-analysis is based on 5 studies and a total of 830 patients. No other reported studies comparing Laser to LF were found up to the final date of search, 30th May 2025. Although the total number of patients is relatively small in each groupexcept Alwadess study 6 , the cumulative data of events is acceptable and represents the current evidence of both techniques. The second limitation of this study is the data curation. Not all data of the six parameters were reported by the 5 studies, and the imputation technique was used. This has had an impact on the final Forest plot. The third limitation is three of the studies did not specify whether the included patients represent simple or complex PNS disease and as such the final analysis is including both. The fourth limitation is some studies did not mention the timeline for diagnosis of recurrence and the general assumption is after two months following initial procedure. The last limitation of this study is the high heterogeneity of some tested events, which possibly indicates that the variability did not occur by random chance. Conclusions Laser is superior to the Limberg flap in less pain and shorter operative time. There was no significant difference in recurrence rate, infection, healing and the need for a new operation between the two groups. Declarations Funding Disclosure: There is no financial support for this study, and no conflict of any kind related to this research Author Contribution A.A. ,S .A and A.H. conceived the study. A.A ,S.A AND A.H . developed the idea and performed thesome of the operations .F.A ,T.K,T.H ,A.H and A.A . aided in the analysis. AA AND AH . supervised the project. All authors discussed the results and contributed to the final manuscript.AA,AH,SA,TH performed the PROCEDURES /.AA,AH,SA,TH, TK,FKA,FAS,OA,HT analyzed the data and CRTICALLY APPRAISED THE PAPER .AA,AH,SA,TH, TK,FKA,FAS,OA,HT contributed to the final version of the manuscript and supervised the project.ALL AUTHORS contributed to the interpretation of the results. AA AND AH took the lead in writingthe manuscript. All authors provided critical feedback and helped shape the research, analysis andmanuscript. References Klin B, Heller ON, Kaplan I. The use of the CO2 laser in pilonidal sinus disease: preliminary results of an ambulatory prospective study. J Clin Laser Med Surg 1990; 8(1): 31 − 7. Odili J, Gault D. Laser depilation of the natal cleft–an aid to healing the pilonidal sinus. Ann R Coll Surg Engl 2002; 84(1): 29–32. Landa N, Aller O, Landa-Gundin N, Torrontegui J, Azpiazu JL. Successful treatment of recurrent pilonidal sinus with laser epilation. Dermatol Surg 2005; 31(6): 726-8. Liyanage A, Woods Y, Javed MA, et al. Laser depilation as adjuvant therapy in prevention of recurrence of pilonidal sinus disease: initial experience of a district general hospital in the UK. Ann R Coll Surg Engl 2020; 102(9): 685-8. Conroy FJ, Kandamany N, Mahaffey PJ. Laser depilation and hygiene: preventing recurrent pilonidal sinus disease. J Plast Reconstr Aesthet Surg 2008; 61(9): 1069-72. Alwadess A, Hussain A, Geddoa E, et al. Laser versus rhomboid flap for sacrococcygeal pilonidal sinus: multi-centre comparative study. Lasers Med Sci 2025; 40(1): 93. Algazar M, Zaitoun MA, Khalil OH, Abdalla WM. Sinus laser closure (SiLaC) versus Limberg flap in management of pilonidal disease: A short-term non-randomized comparative prospective study. Asian J Surg 2022; 45(1): 179 − 83. Bonito F, Cerejeira D, Goulao J, de Assuncao Goncalves J. A Retrospective Study of the Safety and Efficacy of a Radial Diode Laser Probe in the Management of Pilonidal Sinus Disease. Dermatol Surg 2021; 47(9): 1224-8. Akyol H. Sinus laser therapy versus Karydakis flap procedure in the management of pilonidal sinus disease: a comparative analysis of intraoperative parameters and postoperative outcome. Tech Coloproctol 2024; 29(1): 26. Yardimci VH. Outcomes of Two Treatments for Uncomplicated Pilonidal Sinus Disease: Karydakis Flap Procedure and Sinus Tract Ablation Procedure Using a 1,470 nm Diode Laser Combined With Pit Excision. Lasers Surg Med 2020; 52(9): 848 − 54. Dessily M, Charara F, Ralea S, Alle JL. Pilonidal sinus destruction with a radial laser probe: technique and first Belgian experience. Acta Chir Belg 2017; 117(3): 164-8. De Decker M, Sels T, Van Hoof S, et al. Does minimally invasive laser-assisted treatment of pilonidal sinus disease live up to its expectations: a multi-center study with 226 patients. 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Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med2009;151:264-9, W64. doi:10.7326/0003-4819-151-4-200908180-00135 pmid:19622511 Pappas AF, Christodoulou DK. A new minimally invasive treatment of pilonidal sinus disease with the use of a diode laser: a prospective large series of patients. Colorectal Dis 2018; 20(8): O207-O14. Badawy EA, Kanawati MN. Effect of hair removal by Nd:YAG laser on the recurrence of pilonidal sinus. J Eur Acad Dermatol Venereol 2009; 23(8): 883-6. Ouali M. SiLaC(R) with EPSiT(R): early outcomes of laser-endoscopic therapy for pilonidal sinus. Front Surg 2025; 12: 1587467. El Deen MS, Hassan YM, Sorour MA, El Hadad H, Wael M. A Comparitive Study Between Early Outcomes of Laser and Lay-Open Technique in Management of Simple Pilonidal Sinus. Lasers Surg Med 2025; 57(4): 321-8. Awed AA, Duhmaj MB, Al-Aamri H, et al. The Presence of Pilonidal Sinus Infection Before Surgery Versus Other Factors as Predictors of Sinus Recurrence After Surgical Excision: A Retrospective Study. Cureus 2025; 17(1): e77080. Harris CL, Holloway S. Development of an evidence-based protocol for care of pilonidal sinus wounds healing by secondary intent using a modified Reactive Delphi procedure. Part 2: methodology, analysis and results. Int Wound J 2012; 9(2): 173 − 88. Kaba M. New factors affecting wound healing and recurrence after pilonidal sinus surgery in adolescents; seborrheic dermatitis and psychiatric co-occurring conditions. Int Wound J 2024; 21(1): e14404. Brasel KJ, Gottesman L, Vasilevsky CA, Members of the Evidence-Based Reviews in Surgery G. Meta-analysis comparing healing by primary closure and open healing after surgery for pilonidal sinus. J Am Coll Surg 2010; 211(3): 431-4. Binnebosel M, Junge K, Schwab R, Antony A, Schumpelick V, Klinge U. Delayed wound healing in sacrococcygeal pilonidal sinus coincides with an altered collagen composition. World J Surg 2009; 33(1): 130-6; discussion 7. Mohamadi S, Norooznezhad AH, Mostafaei S, et al. A randomized controlled trial of effectiveness of platelet-rich plasma gel and regular dressing on wound healing time in pilonidal sinus surgery: Role of different affecting factors. Biomed J 2019; 42(6): 403 − 10. Sievert H, Evers T, Matevossian E, Hoenemann C, Hoffmann S, Doll D. The influence of lifestyle (smoking and body mass index) on wound healing and long-term recurrence rate in 534 primary pilonidal sinus patients. Int J Colorectal Dis 2013; 28(11): 1555-62. Tables Tab.1: Newcastle-Ottawa quality assessment Study selection compatibility exposure Tyrvainen et al Alwadess et al Algazar et al Chitrambalm et al Additional Declarations No competing interests reported. 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flap\u003c/p\u003e","description":"","filename":"Fig.6needforanewopertaion010525.png","url":"https://assets-eu.researchsquare.com/files/rs-6822266/v1/957e85663d5f7995118fce97.png"},{"id":87046301,"identity":"f6fcfa00-935a-49a9-98bb-02b68eca0ed8","added_by":"auto","created_at":"2025-07-18 14:37:26","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":58110,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA flow chart\u003c/p\u003e","description":"","filename":"Fig.7flowPRISMAchart.png","url":"https://assets-eu.researchsquare.com/files/rs-6822266/v1/fc5fd40e517b812254736b6b.png"},{"id":87232262,"identity":"a5c2694a-806b-42e6-9b09-76bbcc15b871","added_by":"auto","created_at":"2025-07-21 19:31:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2447567,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6822266/v1/2798191d-9cfc-4a3f-a52e-fc48123b0432.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The outcomes of Laser versus Limberg flap for sacrococcygeal pilonidal sinus, meta-analysis study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLaser therapy was first applied in pilonidal surgery and reported in 1990\u003csup\u003e1\u003c/sup\u003e. Since then, different applications of lasers in depilation have been developed to enhance outcomes and prevent recurrence of sacrococcygeal pilonidal sinus (PNS)\u003csup\u003e2\u0026ndash;5\u003c/sup\u003e. Laser application has emerged as a comparable method of treatment, offering a shorter operative time, reduced pain, and easier application, but with a higher recurrence rate in some patients\u003csup\u003e6\u0026ndash;9\u003c/sup\u003e. Laser development enables its use in the PNS tract ablation with variable success rates\u003csup\u003e6,10\u0026ndash;12\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe aetiology of PNS disease is multifactorial, of obesity, long sitting, immune compromise status, hairy area and young age. The presentations of the PNS could be a spectrum of no symptoms to flare-ups of extensive infection and synergistic gangrene\u003csup\u003e13\u0026ndash;15\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe laser effect is administered through the traditional technique after-curettage and irrigation. The laser treatment involves delivering an average energy of 320 joules using a 1470-nm diode laser (1 pulse: 6 s, 15 watts/1 pulse in 6 s\u0026thinsp;=\u0026thinsp;90 joules)\u003csup\u003e16\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eDifferent open techniques are in use to manage sacrococcygeal PNS. They include open flaps, complete primary closure, partial closure, and endoscopic closure \u003csup\u003e17,18\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eComparing lasers to conventional methods has been reported\u003csup\u003e6,7,9,19,20\u003c/sup\u003e. There have been different outcomes of laser and classic interventions.\u003c/p\u003e\u003cp\u003eThere was no meta-analysis (MA) or systematic review study comparing laser to Limberg flap(LF) in literature. This MA aims to report the current evidence of the outcomes of laser versus LF the in the sacrococcygeal PNS disease management.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis MA is based on studies that compare laser to LF. Three authors searched PubMed, Elsevier, Scopus, CINAHL, Google, and Springer platforms for studies that reported and compared laser to LF treatment up to May 2025.160 studies were found, but only five were comparing laser to the LF method and therefore selected\u003csup\u003e6,7,20 21,22\u003c/sup\u003e.PRISMA protocol was used\u003csup\u003e23\u003c/sup\u003e [see PRISMA flow chart,Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e] .The studies period was 2022\u0026ndash;2025. Full text of each study was available, and the data were collected for each parameter of recurrence, operative time, infection, post-operative pain, healing and the need for a new operation.\u003c/p\u003e\u003cp\u003eThe laser studies data were marked as an experimental technique, and the LF as a control group in all analyses and the six Forest plot figures.\u003c/p\u003e\u003cp\u003eJASP software and meta-analysisonline.com statistics were used for analysing the data. The missing data were curated using the imputation technique to enhance reliability, reproducibility and facilitate sharing and use. Six forest plots were produced [Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe quality of the studies was assessed using Newcastle-Ottawa protocol [ see Table\u0026nbsp;1]. \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eFigures \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e show the results of this meta-analysis. There was no significant difference in recurrence after laser or LF [P value was 0.90, heterogeneity was high (52.4%), which may indicate that a significant effect happened because of non-random chance [see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThere was a significant difference in operative time, laser is associated with shorter operative time compared to LF (P value was \u0026lt;\u0026thinsp;0.0001); however, the outcome is also associated with high heterogeneity(I\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;95.3%) [see Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThere was no significant difference in infection rate between the two techniques, P value was 0.26, and the effect is randomly distributed as heterogeneity was zero [ see Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThere was significantly less pain in the laser group, p value\u0026thinsp;\u0026lt;\u0026thinsp;0.0001[see Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e]. I\u003csup\u003e2\u003c/sup\u003e test\u0026thinsp;=\u0026thinsp;0, indicated no heterogeneity.\u003c/p\u003e\u003cp\u003eThere was no difference in healing time (days), p value was 0.43, while heterogeneity was 0 for postoperative pain but very high for healing time at 87.8% [ see Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe laser group did not show a significant difference in the need for new operations compared to LF, p value was 0.17, with 3.1% heterogeneity. The majority of events were likely occurred because of random chance [see Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe most important findings of this analysis are shorter operative time, less pain in laser group and no significant difference in recurrence rate after Laser or LF technique, p value\u0026thinsp;\u0026lt;\u0026thinsp;0.0001, 0.90 respectively. Significant heterogeneity of the analysis for the recurrence may suggest inconsistent effects in magnitude or direction. The I\u003csup\u003e2\u003c/sup\u003e test indicates that 52.4% of the variability among studies arises from heterogeneity rather than random chance.\u003c/p\u003e\u003cp\u003eIn addition to the included 5 studies in this MA ,most of the important laser studies confirmed no difference in recurrence using laser or other open methods \u003csup\u003e7,9,24,25\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eOur analysis also showed the laser group enjoyed shorter operative times compared to the LF technique. There was greater heterogeneity of 95.3%, which means the variability is unlikely to happen by random chance, nevertheless, the laser technique is associated with a shorter time because of no time was spent on excision of tissues or creation a flap\u003csup\u003e26,27,9\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThere was no significant difference in the infection rate, all patients were elective cases with no evidence of active infection at the time of operation. Preoperative presence of such infection was confirmed as a risk factor for recurrence\u003csup\u003e28\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eBoth techniques were conducted under aseptic conditions. Any immune-compromised status has the potential to influence the infection rate.\u003c/p\u003e\u003cp\u003ePost-operative pain score was significantly different for Laser or LF patients, P value\u0026thinsp;\u0026lt;\u0026thinsp;0.0001.\u003c/p\u003e\u003cp\u003eIn Algazar\u0026rsquo;s\u003csup\u003e7\u003c/sup\u003e and Chitrambalam\u0026rsquo;s studies\u003csup\u003e21\u003c/sup\u003e it was significantly less in the Laser group. The other three studies\u003csup\u003e6,21,22\u003c/sup\u003e did not include the pain score data, and data curation was done. Although the I\u003csup\u003e2\u003c/sup\u003e did not show any significant heterogeneity, however the finding should be cautiously interpreted taking in consideration the size of each study compared to the Tyrvainen\u003csup\u003e20\u003c/sup\u003e and Alwadess\u003csup\u003e6\u003c/sup\u003e cohorts.\u003c/p\u003e\u003cp\u003eThere was no significant difference in healing between the two techniques. Healing depends on several factors, including patient factors, surgery types, nutrition, connective tissue collagen, presence of infection or complications of bleeding, excessive and recurrent tissue trauma or ischemia\u003csup\u003e29\u0026ndash;34\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThere was no significant difference in the need for a new operation between the two groups. This was clear and expected, as there was no significant difference in the recurrence and healing.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eThis meta-analysis is based on 5 studies and a total of 830 patients. No other reported studies comparing Laser to LF were found up to the final date of search, 30th May 2025. Although the total number of patients is relatively small in each groupexcept Alwadess study\u003csup\u003e6\u003c/sup\u003e, the cumulative data of events is acceptable and represents the current evidence of both techniques.\u003c/p\u003e\u003cp\u003eThe second limitation of this study is the data curation. Not all data of the six parameters were reported by the 5 studies, and the imputation technique was used. This has had an impact on the final Forest plot.\u003c/p\u003e\u003cp\u003eThe third limitation is three of the studies did not specify whether the included patients represent simple or complex PNS disease and as such the final analysis is including both.\u003c/p\u003e\u003cp\u003eThe fourth limitation is some studies did not mention the timeline for diagnosis of recurrence and the general assumption is after two months following initial procedure.\u003c/p\u003e\u003cp\u003eThe last limitation of this study is the high heterogeneity of some tested events, which possibly indicates that the variability did not occur by random chance.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eLaser is superior to the Limberg flap in less pain and shorter operative time. There was no significant difference in recurrence rate, infection, healing and the need for a new operation between the two groups.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eFunding Disclosure:\u003c/p\u003e\n\u003cp\u003eThere is no financial support for this study, and no conflict of any kind related to this research\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eA.A. ,S .A and A.H. conceived the study. A.A ,S.A AND A.H . developed the idea and performed thesome of the operations .F.A ,T.K,T.H ,A.H and A.A . aided in the analysis. AA AND AH . supervised the project. All authors discussed the results and contributed to the final manuscript.AA,AH,SA,TH performed the PROCEDURES /.AA,AH,SA,TH, TK,FKA,FAS,OA,HT analyzed the data and CRTICALLY APPRAISED THE PAPER .AA,AH,SA,TH, TK,FKA,FAS,OA,HT contributed to the final version of the manuscript and supervised the project.ALL AUTHORS contributed to the interpretation of the results. AA AND AH took the lead in writingthe manuscript. All authors provided critical feedback and helped shape the research, analysis andmanuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e Klin B, Heller ON, Kaplan I. The use of the CO2 laser in pilonidal sinus disease: preliminary results of an ambulatory prospective study. J Clin Laser Med Surg 1990; 8(1): 31\u0026thinsp;\u0026minus;\u0026thinsp;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Odili J, Gault D. Laser depilation of the natal cleft\u0026ndash;an aid to healing the pilonidal sinus. Ann R Coll Surg Engl 2002; 84(1): 29\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Landa N, Aller O, Landa-Gundin N, Torrontegui J, Azpiazu JL. Successful treatment of recurrent pilonidal sinus with laser epilation. 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Biomed J 2019; 42(6): 403\u0026thinsp;\u0026minus;\u0026thinsp;10.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Sievert H, Evers T, Matevossian E, Hoenemann C, Hoffmann S, Doll D. The influence of lifestyle (smoking and body mass index) on wound healing and long-term recurrence rate in 534 primary pilonidal sinus patients. Int J Colorectal Dis 2013; 28(11): 1555-62.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTab.1: Newcastle-Ottawa quality assessment\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eStudy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eselection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003ecompatibility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eexposure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTyrvainen et al\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cimg width=\"17\" height=\"17\" src=\"data:image/png;base64,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\" alt=\"Single gear\"\u003e\u003cimg width=\"17\" height=\"17\" src=\"data:image/png;base64,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\" alt=\"Single gear\"\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cimg width=\"17\" height=\"17\" src=\"data:image/png;base64,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\" alt=\"Single gear\"\u003e\u003cimg width=\"17\" height=\"17\" src=\"data:image/png;base64,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\" alt=\"Single gear\"\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cimg width=\"17\" height=\"17\" src=\"data:image/png;base64,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\" alt=\"Single gear\"\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAlwadess et al\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cimg width=\"17\" height=\"17\" src=\"data:image/png;base64,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\" alt=\"Single gear\"\u003e\u003cimg width=\"17\" height=\"17\" src=\"data:image/png;base64,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\" alt=\"Single gear\"\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cimg width=\"17\" height=\"17\" src=\"data:image/png;base64,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\" alt=\"Single gear\"\u003e\u003cimg width=\"17\" height=\"17\" src=\"data:image/png;base64,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\" alt=\"Single gear\"\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cimg width=\"17\" height=\"17\" src=\"data:image/png;base64,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\" alt=\"Single gear\"\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAlgazar et al\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cimg width=\"17\" height=\"17\" src=\"data:image/png;base64,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\" alt=\"Single gear\"\u003e\u003cimg width=\"17\" height=\"17\" src=\"data:image/png;base64,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\" alt=\"Single gear\"\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cimg width=\"17\" height=\"17\" src=\"data:image/png;base64,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\" alt=\"Single gear\"\u003e\u003cimg width=\"17\" height=\"17\" 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Meta-Analysis","lastPublishedDoi":"10.21203/rs.3.rs-6822266/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6822266/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThe introduction of laser treatment for sacrococcygeal pilonidal sinus has sparked debate about the most effective management approach. This study aims to summarize current evidence comparing the laser and Limberg flap techniques for treating this condition.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eDatabases including PubMed, Elsevier, Scopus, CINAHL, Google, and Springer were searched for studies comparing laser treatment to Limberg flap up to May 2025. PRISMA protocol was used .Data were collected for recurrence, operative time, infection, post-operative pain, healing, and the need for reoperation. JASP software and Meta-analysis online.com were used for statistical analysis. Missing data were addressed using imputation techniques. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eLaser treatment was associated with significantly shorter operative times and less post-operative pain (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001 for both). No significant differences were observed between laser and Limberg flap in recurrence, infection, healing time, or the need for additional operations (p value\u0026thinsp;=\u0026thinsp;0.90, 0.26, 0.43, 0.17, respectively).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eLaser application results in shorter operative times and reduced post-operative pain but shows no significant differences from the Limberg flap in recurrence, infection, healing, or need for further surgery.\u003c/p\u003e","manuscriptTitle":"The outcomes of Laser versus Limberg flap for sacrococcygeal pilonidal sinus, meta-analysis study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-18 14:29:21","doi":"10.21203/rs.3.rs-6822266/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"08307a69-333c-4fa9-9f79-d364227dc2a3","owner":[],"postedDate":"July 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-21T19:23:17+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-18 14:29:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6822266","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6822266","identity":"rs-6822266","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}