<p>Background: Pilonidal sinus represents a prevalent chronic condition localized in the sacrococcygeal region.The present study aims to evaluate and relate the perioperative outcomes of the rhomboid flap technique versus deep suturing in the treatment of recurrent sacrococcygeal pilonidal disease. Methods: This a randomized controlled clinical trial was performed on a sample of 64 patients, aged 18–60 years and both sexes with prior management of pilonidal disease. Participants were assigned randomly to two groups, 32 patients underwent Rhomboid flap approach and 32 patients underwent deep suturing technique. Results: The rhomboid flap approach had a significantly longer operation time compared to deep suturing approach (<i>P</i> &lt; 0.001). Intraoperative bleeding was insignificant differences between the two groups. At the time of stitch removal, the rhomboid flap group reported significantly lower pain relative to the deep suturing group (<i>P</i> &lt; 0.001). The pain duration, pain-free sitting, pain-free toileting, complete wound healing, the rhomboid flap approach showed significantly faster recovery times than the deep suturing approach. The rhomboid flap technique showed a lower recurrence rate compared to deep suturing (6.25% vs. 18.75% respectively), but the difference was not markedly significant. A significantly improved patient satisfaction was observed in the rhomboid flap group relative to the deep suturing group (<i>P</i> = 0.016). Conclusion: In the management of recurrent sacrococcygeal pilonidal disease, the rhomboid flap reconstruction demonstrates lower pain at stitch removal faster complete healing and prompt return to function with better patient satisfaction compared to deep suturing. However, The rhomboid flap approach had a significantly longer operation time.</p>