Background: Pilonidal sinus is a disease that most commonly rises in the hair follicles of the natal cleft of the sacrococcygeal area.

Objective: The aim of the present study was to compare the Rhomboid flap and the semi closure technique for the treatment of recurrent pilonidal sinus.

Patients and methods: This prospective randomized comparative study includes thirty patients with complex sacrococcygeal pilonidal sinus. Patients were divided equally into group (A) patients who underwent semi-closure technique and group (B) patients who underwent rhomboid flap technique. Follow up of both groups done during postoperative care and at time of 2nd, 3rd, 4th and 6th post-operative months.

Results: 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.

Conclusion: Patient experienced rhomboid flap technique shows a decrease in the duration of pain and time need for sitting comfortably and an early return to work and normal daily activity.