Pilonidal sinus: excision and primary closure with a lateralised wound - the Karydakis operation.

In a personal series, forty-five patients with postanal pilonidal sinus have been treated by the Karydakis operation. The sinus is excised using an eccentric elliptical incision, the medial edge of which is undermined and advanced across the midline to produce a lateral vertical scar and shallower natal cleft. Forty patients were followed up for an average of thirty-three months. There were two wound haematomata, four wound infections and two recurrences, one of which was not in the scar. A low recurrence rate can be achieved by flattening the natal cleft and closing the skin away from the midline.