الفهرس 
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Abstract
Introduction: Pilonidal sinus (PNS) is a worldwide problem affecting, usually, young age with high rate for recurrence that causes significant problems if not dealt appropriately in the primary setting. The ideal surgical technique for the treatment of PNS should involve minimal financial cost, allow patients to return earlier to work, be simple to perform, not require a prolonged hospital stay, inflict minimal pain, and have a low disease recurrence rate.The Aim of this study: to compare the outcomes of open versus Karydakis flap procedure in surgical management of pilonidal sinus. Materials and methods: This prospective study conducted from June 2019 till December 2019 in General Surgery department, Mansoura University hospital. The study included 50 cases with pilonidal disease who were presented to Mansoura University Hospitals. The cases were randomly divided into two equal groups according to the surgical repair technique; group I that included cases who underwent the open approach and group II that included cases who underwent Karydakis flap procedure. All cases were subjected to complete history taking, thorough physical examination, and routine laboratory investigations. Results: The operative time was statistically significant lower in the open group as compared with Karydakis group. The time to return to work, time to walk pain free post-operative and time to painless toilet seat post-operative were significantly lower in the Karydakis group as compared with the open group. No significant difference was detected between the two groups as regarding of the early post-operative complications including bleeding and urine retention. The incidence of numbness and hypothesia was significantly higher in the open group. The severity of pain was significantly lower in the Karydakis group as compared with the open group. More patients’ satisfaction was reported in the Karydakis group. The incidence of recurrence was low with only 1 case with recurrence in the Karydakis group within 6 months of follow up. Conclusion: As both complication and recurrence rates did not differ between the two approaches, it is recommended to perform the Karydakis approach due to its advantages. However, operative time was significantly longer with it.