Background: Sacrococcygeal pilonidal sinus disease is one of the most common annoying conditions that affecting commonly sacrococcygeal area. The best management of that disease is surgical treatment. Although many surgical methods used for treatment, recurrence rate is still the main challenge for all techniques. Karydakis procedure is one of the most commonly used methods for management of pilonidal sinus. Objective: In this study we tried to compare usual Karydakis procedure and tie over with pressing interrupted sutures as management for pilonidal sinus as regard rate of recurrence, wound complication and hospital stay and off-work time. Patients and methods: This is a prospective study done over 75 patients of sacrococcygeal pilonidal sinus who were divided in two groups (group A) included 35 patients managed by Karydakis procedure and (group B) included 40 patients managed by tie over with pressing interrupted sutures, between June 2017 till May 2019 . Results: In group B all patients were discharged on the same day of surgery but in group A the mean hospital stay was of 3.9 ± 2.4 days. Three patients in group A developed seroma compared with one patient in group B. In group A, 11.4% of patients developed wound infection compared with 2.5% in group B. Three patients in group A had recurrence but No recurrences were noted in group B, although our study was limited as the duration of follow-up was short to accurately weigh recurrence rate. Conclusion: Tie over with pressing interrupted sutures is safe than usual Karydakis procedure with less hospital stay and less recurrence rates.