Aim: The Purpose of this study was to compare Karydakis procedure (KP) with the modified Limberg flap 
(MLF) in the treatment of recurrent and complex sacrococcygeal pilonidal disease.
Methods: Sixty patients were randomized into two groups: Group I (30 patients) the mean age was 29 ± 7.2 
years (22 men) underwent excision and (KP) and Group II (30 patients) the mean age was 28 ± 6.6 years (21 
men) that underwent (MLF). Follow up (months) was 23.2 ± 7.65 for group I and 21.6 ± 8.32 for group II. 
Results: The operative time (minute) for group I was 49.8 ± 7.3 which was significantly less than that for 
group II 52.7 ± 5.3. However, there was no significant difference between both groups as regard hospital stay, 
pain score, period off work, and healing period Postoperative follow-up showed that there was no significant 
difference between both groups as regard incidence of complications. Meanwhile recurrence occurs in only 
one case 3.33 in both groups
Conclusion: Karidakis procedure should be the preferred method in treatment of recurrent and complex 
sacrococcygeal pilonidal disease, and Modified Limberg flap is relatively major procedure and its results was 
comparable to Karidakis method.