Comparative study of the Karydakis flap versus conventional surgical techniques for pilonidal sinus disease: a systematic review and meta-analysis.
Alaa Hussain Alwan Alsalaumy
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In 30 seconds
This systematic review and meta-analysis compared the Karydakis flap (KF) with midline closure (MC) and excision with healing by secondary intention (EHSI) for pilonidal sinus disease. It included randomised and comparative cohort studies published through February 2025, comprising 3,108 patients across 15 studies. KF was associated with lower recurrence than both comparators: versus MC, OR 0.30 (95% CI 0.16-0.59; p < 0.001), and versus EHSI, OR 0.29 (95% CI 0.12-0.71; p = 0.006). KF was also associated with earlier return to work.
Key findings
- Recurrence was lower with KF than MC (OR 0.30, 95% CI 0.16-0.59; p < 0.001; I 2 = 34%).
- Recurrence was lower with KF than EHSI (OR 0.29, 95% CI 0.12-0.71; p = 0.006; I 2 = 11%).
- KF was associated with fewer infections than EHSI (OR 0.06, 95% CI 0.007-0.486; p = 0.008).
- Return to work was earlier with KF than MC (MD - 6.5 days) and EHSI (MD - 18.9 days).
Why it matters
Recurrence and recovery time are important outcomes when selecting surgery for pilonidal sinus disease. Across the included comparative studies, KF was associated with lower recurrence than both midline closure and excision with secondary-intention healing, as well as earlier return to work. These findings help frame comparisons among surgical approaches, while the mixed study designs warrant care in interpreting the estimates.
What to keep in mind
The review combined randomised and comparative cohort studies, so the pooled associations may be affected by differences in study design. The abstract does not report further limitations.