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Abstract One of the most important surgical issues applied in the treatment of pilonidal sinus disease is wound healing. The aim of this study is to compare two surgical techniques (rhomboid flap and semiclosure method) of treatment of complex pilonidal sinus. This prospective randomized comparative study includes thirty patients with complex sacrococcygeal pilonidal sinus which was carried out in the department of General surgery, Zagazig University Hospitals in the period from May 2023 to November 2023. These patients were then divided randomly into two groups: group A 15 patients were managed by semiclosure technique with regular dressing and group B 15 patients were operated by rhomboid flap technique. Before treatment, all patients were evaluated clinically to exclude any patient who met exclusion criteria. These patients were presented by a variant of symptoms varies between pain and discharge or both. Their age range from 18-37 years with the mean age 25 years and a male predominance of 86.5 % All patients in both groups were followed postoperative to evaluate wound healing every 3 days for the first12 days and every 5 days for the next 12 days and then every week till complete healing are achieved then at time of the 2nd, 3r , 4th and 6th post-operative months . Patients in group B experience a decrease in the duration of pain and time need for sitting comfortably and an early return to work and normal daily activity. Summary 59 There was a significant difference regarding pain duration, time of comfort sitting, total time of healing and time of return to work between the two groups for favor of group B which was markedly short in patients of group B. It was found that post-operative wound complications as regards delayed wound healing, wound infection and wound dehiscence were more with patients operated by rhomboid flap than semi closure technique. According to post- operative recurrence, follow up of both groups done during postoperative care and also at time of 2d,3rd, 4th and 6th post-operative months . onlythree cases of group B had recurrence which presented with pain in the 4th post-operative month and complicated with pus discharge at time of 6th month with no recurrence with cases reported during the 6th post-operative months in group A . Our study limitations included: relative small sample size, use of subjective evaluation and the short period of our study (6 months) limit the further evaluation of any other possible recurrence in both groups |