Pilonidal sinus treatment with laser, without a large open wound to pack.
Laser closure seals the tunnel through the small pits it already has. Dr Daniel Lee will tell you honestly when it suits you and when it doesn't.
Laser pilonidal sinus treatment in four numbers.
These are averages from a 311-patient multicentre study of laser pilonidal treatment, not a prediction for you.
The tunnel is cleared, then sealed from inside through the pits.
Loose hairs work their way into the skin of the buttock crease and set up a tunnel underneath, with small holes (pits) along the midline. It tends to get infected, drain, settle and flare again. It is common in young adults, especially people who sit a lot.
In SiLaC (sinus laser-assisted closure), Dr Lee cleans the pits and clears the hair and debris from the tunnel. He then passes a thin laser fibre in and draws it back slowly, about 1 mm a second, while cool wet gauze is pressed on the skin. The heat shrinks the tunnel's walls and seals it.
When the tunnel branches or has come back before, he uses a small camera first (EPSiT) to see inside and clean every branch, then seals it with laser. It's the same idea as laser closure for an anal fistula: seal the tunnel, keep the healthy tissue.
- Pits in the midline of the buttock crease
- The tunnel under the skin, with trapped hair
- Heat at the fibre tip seals the tunnel as it's drawn back
- A side opening, where the tunnel can also drain
Honestly these problems are way more common than you think and we see this all the time. And the truth of the matter is that there's nothing to be embarrassed about.
Signs of a pilonidal sinus at the base of the spine.
It is often mistaken for a boil or a cyst. If these sound familiar, it's worth getting it looked at properly.
- Small holes or pits in the crease at the top of the buttocks
- Pain or swelling at the base of the spine, worse when you sit
- Pus or blood leaking from the area, sometimes with hair in it
- A lump that gets infected, settles, then flares up again
A hot, very painful swelling with fever needs care the same day.
That's usually an abscess. It is drained first to let the infection settle, and laser treatment of the tunnel is planned afterwards.
Who laser pilonidal sinus treatment suits, and who it doesn't.
Dr Lee matches the technique to the tunnel. Simple, first-time tunnels do well with laser alone; branching ones need the camera too.
Laser is a good fit for
- A first-time pilonidal sinus with a few pits, where laser alone is often enough
- Branching tunnels, or a sinus that's come back after surgery, using the camera and laser together
- Anyone who wants to avoid a large open wound, daily packing and weeks off
Another option may serve you better
- An active abscess, which is drained first
- Very widespread disease with a lot of scarring, where cutting it out and closing with a flap may still be the better choice
From first visit to a closed wound, one step at a time.
Here is what happens at each stage, and roughly when.
- First visit
Examination and a plan
Dr Lee counts the pits, looks for side openings and checks for infection. He explains whether laser alone, camera plus laser, or surgery suits your tunnel.
- If infected
Drain first, laser later
An active abscess is drained and allowed to settle before the tunnel is treated.
- Procedure day
Laser closure as a day procedure
Under anaesthetic, the pits are cleaned, the hair cleared out, a camera used where needed, and the tunnel sealed with laser. Most people go home the same day.
- First weeks
Small openings, no packing
The pits and any side opening drain a little while the tunnel heals. A daily shower and a clean dressing are usually all that's needed.
- Until closed
Reviews until it's healed
Dr Lee checks the wound until the openings have closed, on average about 6 weeks in a 311-patient multicentre study.
How laser compares with cutting out a pilonidal sinus.
Every option trades how much tissue is removed against how long the wound takes to heal.
| Option | What happens | The wound | The trade-off |
|---|---|---|---|
| Cut out, left open | The whole area is cut out and heals from the base up | A large open wound, packed and dressed for weeks | Slow to heal, with a long stretch of dressings |
| Cut out, flap closure | Cut out, then closed by moving a flap of nearby skin across | Closed wound, larger scar; lying on your front or side at first | Wound breakdown varies widely between studies, up to 45% in one trial |
| Laser (SiLaC) | Laser through the pits seals the tunnel from inside | Small openings that drain for a few weeks, no packing | About 1 in 4 came back within about 10 months in a 311-patient study; laser can be repeated |
| Camera plus laser (EPSiT, E-SiLaC) | A camera maps and cleans every branch, then laser seals it | Small openings, no packing | Newer, with encouraging early results but short follow-up |
Flap wound breakdown varies widely between trials and reached 45% in one multicentre trial. Laser recurrence comes from a 311-patient multicentre study, and camera plus laser from an 83-patient single-centre study. Figures come from different studies and cannot be compared head to head.
What published research says about laser pilonidal sinus treatment.
These are results from other surgeons' published studies, not a promise of your result. Each one links to the paper.
Two in three heal with one procedure
In 311 patients across several hospitals, 66% were healed by the first laser procedure. Counting repeat procedures, success reached 92% after a second and 98% after a third. About 1 in 4 came back over about 10 months of follow-up.
Most need little or no pain relief
In the same study 55.6% needed no painkillers at all and another 28.3% only paracetamol. People were back at work or sport in about 6 days on average, and rated their satisfaction 9 out of 10.
Longer follow-up
In a 200-patient study, 94% healed, in 19.5 days on average, after an operation of about 9 minutes. Over longer follow-up, 14.9% of those who answered (77.5% of patients) had it come back.
Camera plus laser
In 83 patients treated with a camera and laser together, wounds healed in 17.3 days on average and 3.6% came back within 6 months. It's a single-centre study with short follow-up.
Recovery after laser pilonidal sinus treatment, week by week.
No packing
There's no large open wound, so there is no daily packing. The small openings drain a little; a shower and a fresh dressing each day are usually enough.
Back to work or study in about a week
On average, people were back at work or sport in about 6 days. Dr Lee advises when to go back to sport and long periods of sitting.
Healing, then keeping it away
The openings close over a few weeks. Keeping the area clean and dry helps, and Dr Lee talks you through what lowers the chance of it coming back.
Fees for pilonidal sinus treatment, and how MediSave and insurance apply.
Your fee is explained clearly at consultation, before anything is scheduled. Laser pilonidal treatment is usually a day-surgery procedure.
Cost at a glance
Nearest national benchmark: conventional (open) pilonidal sinus excision, TOSP SF800S
Surgeon’s fee (national benchmark, GST included)
from SGD 2,834
MOH range SGD 2,834 to 3,597is for the conventional (open) surgery, not the laser version; MOH publishes no laser-specific figure, so use it as a rough guide only. Dr Lee’s own laser fee may sit inside or outside this range and is confirmed at consultation.
Anaesthetist’s fee (national benchmark, GST included)
from SGD 817.50
MOH range SGD 817.50 to 1,199. The anaesthetist bills separately; the clinic puts the fee in your written estimate.
Hospital and day-surgery fees
quoted when you ask
Billed separately, and shown in your written estimate.
What will you pay in cash?
It depends on your insurer and plan, so the clinic works it out for you.
Leave your name and mobile, then add your insurer and plan name. No IC or policy number needed. You get the estimate in writing, before anything is booked. The estimate is information only, the decision stays yours.
You can check surgeon fees against the published MOH fee benchmark page.
Anaesthetist and hospital fees are charged separately and vary by hospital.
Paying with MediSave and insurance
Checked for your case
Whether MediSave applies, and how much, depends on how the procedure is coded under MOH's Table of Surgical Procedures and its withdrawal limits. The team checks this before you book.
Your plan, confirmed first
Many Integrated Shield Plans cover pilonidal sinus surgery, but plans differ. The team helps you get pre-authorisation where your insurer asks for it.
We handle the forms
The team fills in the claim forms and liaises with your insurer where possible, so you can focus on getting better.
The plans we work with.
Dr Daniel Lee practises with Colorectal Clinic Associates (CCA). The clinic works with the insurers below, and the team assists with claims and eligibility checks.
Pilonidal sinus treatment, answered plainly.
Will I need wound packing after laser treatment?
How soon can I sit, work or go back to school?
Can a pilonidal sinus come back after laser?
What is the difference between SiLaC, EPSiT and E-SiLaC?
Does laser pilonidal treatment hurt afterwards?
Will there be a scar?
Is pilonidal sinus treatment covered by MediSave or insurance?
Pilonidal sinus treatment at five private hospitals.
Related conditions and treatments.
A short message is enough to begin.
Send your name, number and what you're noticing. Dr Lee's team will reply on WhatsApp and find a time and place that suits you.