This technique follows the most classical principles of sinus surgery, in which the skin and all fatty tissue is removed down to the sacral bone, leaving the wound open.

Despite being discouraged by most authors for generating large wounds and slow healing, this technique is by far the most used today by surgeons throughout Spain because it is a simple technique to perform, fast and to some extent by habit.

Consequences: great affectation of the quality of life in the postoperative period, since it requires annoying or painful daily cures, carried out in a medical center, sometimes for several months, so that life is organized around the time of the cure. It is not allowed to play sports, swim in the pool or sea, and the recovery time until you can return to a normal activity (studies or work) can be extended a minimum of 8-10 weeks.

The removal of the sinus is performed in the same way as in the previously described technique, and although the skin wound is closed with stitches, as the suture remains in the center of the crease between the buttocks, there is a good degree of tension in it.

This tension in the suture can increase postoperative pain, which together with the fact that no plasty has been performed to modify the local conditions of the deep fold between the buttocks, persisting a poorly ventilated, friction and humid area, favors closure failure, which occurs in approximately 50% of the cases, leaving the wound open and requiring cures as in the open technique described above.

The risk of sinus recurrence over the years is somewhat higher than with other techniques.

It consists of the removal of the pores or fistulous orifices located in the crease between the buttocks with very small incisions and the cleaning, through a small lateral incision, of the main cavity of the pilonidal sinus located under the skin.

It is a minimally invasive technique, with good postoperative pain control, a fairly rapid recovery and does not require very long cures.

However, it can only be performed in selected, mildly symptomatic cases with few midline fistulous orifices and no signs of chronic inflammation. In addition, it does not correct the cause of the pilonidal sinus, so there is a possibility of new pilonidal sinuses in the long term.

With this minimally invasive technique, cauterization is performed from within the pilonidal sinus cavity and its subcutaneous tracts by introducing a filament that emits laser energy through very small incisions, thus largely preserving the skin surface of the intergluteal fold.

This technique has good postoperative pain control and a fairly rapid recovery and postoperative cures can usually be performed at home.

As with the “Pit picking” technique, it should only be performed in selected cases.

It consists of a minimally invasive endoscopic technique. Under direct vision, using a millimeter fistuloscope, the surgeon inspects all the fistulous tracts and secondary cavities of the pilonidal sinus, extracting all the hair and follicles, subsequently cauterizing the tracts.

This technique has good postoperative pain control and a fairly rapid recovery and postoperative cures can usually be performed at home.

Like the pit picking technique and laser treatment (SiLaC) it should only be performed in selected cases. This is a novel technique whose long-term results have yet to be validated.

The modified Karydakis procedure, also called Bascoms cleft lift procedure, is the most frequently recommended technique because of its excellent results.

It consists of a minimized and eccentric removal of the sinus, keeping as much tissue as possible, with the double intention of flattening the intergluteal groove somewhat and taking the suture line out of the midline.

It is a very effective technique in the long term, by modifying the local conditions of the fold between the buttocks, which is the primary cause of pilonidal sinus, obtaining a very low recurrence rate.

In addition, it achieves an excellent esthetic result and little postoperative pain, especially compared to the most common techniques.

There are multiple techniques described, such as the Limberg flap, Z-plasty, rotation flap, etc.

In all of them the approach is to repair the wound caused by removing the sinus by displacing healthy surrounding tissue to achieve adequate wound closure.

These flaps require modification of a large area of skin around the wound. They are technically more complex, have worse cosmetic results compared to the modified Karydakis flap, and should be reserved for selected larger cases.