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Introduction: Pilonidal sinus is an infectious disease in the natal cleft caused by insertion of loose hair under subcutaneous tissue. Surgical operation is considered standard therapy for pilonidal sinus. We had performed excision with midline closure or excision with open wound, but experienced dehiscence after the operation in many cases after excision with midline closure, and recurrence after excision with open wound. Methods: We operated on 20 patients with pilonidal sinus in 2012-2022: 7 excision with midline closure, 4 excision with open wound, and 9 Karydakis flap. We evaluated the operating time, complete healing time, dehiscence, wound infection and recurrence in each group. Result: In the excision with midline closure group, dehiscence occurred in all cases. Operating time was 38 minutes, complete healing time was 120 days, and there was one case of recurrence. In the excision with open wound group, the operating time was 24 minutes, complete healing time was 134 days, and there was one case of recurrence. In the Karydakis flap group, the operating time was 57 minutes, complete healing time was 37 days, and there were two cases of dehiscence and no cases of recurrence. Conclusion: Shorter complete healing time and lower recurrence rate can be expected with Karydakis flap for pilonidal sinus, although the operation time is longer. [ABSTRACT FROM AUTHOR]