From the *Department of Sur- gery, KOC Ahmadi Hospital, Ah- madi, Kuwait Oil Company, Ku- wait; and the †Department of Surgery, Faculty of Medicine, University of Alexandria, Egypt. Reprints: Mahmoud Sakr, MD, PhD, Department of Surgery, KOC Ah- madi Hospital, Kuwait Oil Com- pany (KOC), Ahmadi 61008, Ku- wait. E-mail: mah_sakr@yahoo.com. Copyright © 2006 by Lippincott Williams & Wilkins ISSN: 1542-5983/06/1204-0201 Original Articles Assessment of Karydakis Technique as Compared With Midline Closure for the Management of Chronic Pilonidal Sinus Mahmoud Sakr, MD, PhD,*† Mahmoud Habib, FRCS(Ed),* and Atef A. Shaheed, (FRCS)* Abstract Objectives: Different procedures have been advo- cated for the management of chronic pilonidal si- nus (PNS), none of which is perfect. This study was conducted to compare between the Karydakis tech- nique and conventional midline closure in patients with chronic PNS. Methods: This study included 161 patients with chronic PNS admitted to the department of surgery between June 2001 and June 2004. Data collected included demographics, symptoms and their dura- tion, number of sinuses and their location, previ- ous management, operative technique and time, hospital stay, return to normal activity, morbidity, and recurrence of disease. Patients were catego- rized into 2 groups. Patients in group 1 (n  79) were treated with the Karydakis asymmetric eccen- tric flap, whereas those in group 2 (n  82) were treated with the standard midline closure tech- nique. Mean follow up was 30.4 months (range, 12– 49 months). Results: Both groups had similar demographics, clinical presentation, hospital stay, and time of return to usual activity. Operative time was insig- nificantly longer with the Karydakis technique (mean, 45.2 versus 40.4 minutes). Overall compli- cation rate was significantly more in patients with midline closure (17 of 82 20.73% ) as compared with those with the Karydakis procedure (7 of 79 8.86% )(P < 0.05). Recurrence was observed in 9 patients (10.97%) with midline closure as com- pared with only 2 (2.5%) in patients with the Kary- dakis technique (P < 0.05%). Conclusions: The Karydakis technique for man- agement of chronic PNS is a simple, nonlengthy procedure that has less overall complications and a lower recurrence rate than the conventional mid- line closure method. Key Words: pilonidal sinus, Karydakis, asymmet- ric flap (J Pelvic Med Surg 2006;12:201–206) C hronic pilonidal sinus (PNS) is a com- mon disabling disorder among young adults. 1 It has a high and rising incidence in some countries, particularly so in the Mediter- ranean and Gulf region as a result of differing hair characteristics and growth patterns. 2,3 The management remains controversial and recent reports have advocated different surgical pro- cedures, none of which is perfect judged by the yardsticks of primary healing and recur- rence of disease. 4 An operation that results in reliable primary wound healing and few wound management problems, a short pe- riod of hospitalization, minimal postopera- tive pain and morbidity, rapid return to nor- mal daily activity, and low risk of recurrence are seen as requirements to optimal therapy. Karydakis 2,5 has described a technique of asymmetric natal cleft wound closure for treating and preventing recurrence of PNS with a 90% success rate. The present prospective comparative study was conducted to compare the Kary- dakis technique and conventional midline closure for the management of chronic PNS regarding duration of the operation, wound healing, hospital stay, morbidity, and recur- rence of the disease. SUBJECTS AND METHODS Study Population This study included 161 consecutive patients with chronic PNS admitted to the department of surgery of Ahmadi Hospital between June 2001 and June 2004. All data were collected prospectively and included demographics, symptoms and their duration, 201 Journal of PELVIC MEDICINE & SURGERY Volume 12, Number 4 July/August 2006 DOI: 10.1097/01.spv.0000217399.78641.43