Pilonidal sinus: open, stitched or laser?
The short answer
Open excision has the lowest chance of coming back but heals slowest; laser recovers fastest but is the likeliest to come back.
Open excision
- What it is
- The whole sinus is removed and the wound is left open to heal gradually.
- Operation time
- 30–60 minutes
- Healing
- 4–8 weeks; daily wound care.
- Back to work
- 4–6 weeks; light activity in 1 week.
- Coming back
- 5–10%, the lowest.
- Wound infection
- 5–10%
- Bleeding
- 1–2%
- Good to know
- Avoids tension on the wound edges. Needs the longest wound care.
Excision with stitches (primary closure)
- What it is
- The whole sinus is removed and the edges are closed straight away; a drain may be placed for 1–2 days.
- Operation time
- 30–60 minutes
- Healing
- 2–4 weeks; stitches out after 10–14 days.
- Back to work
- 2–3 weeks if uncomplicated.
- Coming back
- 10–15%
- Wound infection
- 10–12%
- Bleeding
- 2–3%
- Good to know
- Higher risk of wound infection or the wound opening again.
Laser
- What it is
- A small cut and a laser fibre to ablate the sinus; very little tissue is removed.
- Operation time
- 20–40 minutes
- Healing
- 1–2 weeks.
- Back to work
- Usually 1 week.
- Coming back
- 15–20%
- Wound infection
- 5–8%
- Bleeding
- Under 2%
- Good to know
- Minimal pain, small scar. Not suitable for a large or complex sinus.
How the choice is made
Your surgeon chooses with you, based on the size and complexity of the sinus, how soon you need to be back to normal, and how you weigh healing time against the chance of it coming back. Hair control and hygiene help prevent it returning, whichever you choose.
This page gives general information and does not replace the advice of your treating team. Figures are approximate.