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<p>The ideal surgical treatment for pilonidal sinus disease (PSD) is controversial. The Karydakis flap (KF) was compared with midline closure (MC) and excision with healing by secondary intention (EHSI). A systematic review and meta-analysis of randomised and comparative cohort studies (through February 2025) was performed. The primary outcomes included recurrence and infection, whereas secondary outcomes were seroma, operative time, hospital stay, overall complications, and return to work. The effect sizes were identified using odds ratios (OR) or mean differences (MD) with 95% confidence intervals (CI), using random-effects models. Fifteen studies (n = 3,108) were identified for inclusion (KF = 1,257, MC = 1,593, EHSI = 258). KF was associated with a significant reduction in recurrence compared to MC (OR 0.30, 95% CI 0.16–0.59; <i>p</i> &lt; 0.001; I<sup>2</sup> = 34%) and EHSI (OR 0.29, 95% CI 0.12–0.71; <i>p</i> = 0.006; I<sup>2</sup> = 11%). KF had fewer infections than EHSI (OR 0.06, 95% CI 0.007–0.486; <i>p</i> = 0.008) and returned to work earlier compared with MC (MD − 6.5&#xa0;days) and EHSI (MD − 18.9&#xa0;days). Hospital stay did not differ between KF and MC (MD − 0.08&#xa0;days). KF provides lower recurrence and faster recovery compared with MC and EHSI, supporting its use as the preferred surgical technique for PSD.</p>

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Comparative study of the Karydakis flap versus conventional surgical techniques for pilonidal sinus disease: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2026年3月19日

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  • Alaa Hussain Alwan Alsalaumy

摘要

The ideal surgical treatment for pilonidal sinus disease (PSD) is controversial. The Karydakis flap (KF) was compared with midline closure (MC) and excision with healing by secondary intention (EHSI). A systematic review and meta-analysis of randomised and comparative cohort studies (through February 2025) was performed. The primary outcomes included recurrence and infection, whereas secondary outcomes were seroma, operative time, hospital stay, overall complications, and return to work. The effect sizes were identified using odds ratios (OR) or mean differences (MD) with 95% confidence intervals (CI), using random-effects models. Fifteen studies (n = 3,108) were identified for inclusion (KF = 1,257, MC = 1,593, EHSI = 258). KF was associated with a significant reduction in recurrence compared to MC (OR 0.30, 95% CI 0.16–0.59; p < 0.001; I2 = 34%) and EHSI (OR 0.29, 95% CI 0.12–0.71; p = 0.006; I2 = 11%). KF had fewer infections than EHSI (OR 0.06, 95% CI 0.007–0.486; p = 0.008) and returned to work earlier compared with MC (MD − 6.5 days) and EHSI (MD − 18.9 days). Hospital stay did not differ between KF and MC (MD − 0.08 days). KF provides lower recurrence and faster recovery compared with MC and EHSI, supporting its use as the preferred surgical technique for PSD.