The Karydakis procedure is a well-established surgical technique for treating pilonidal sinus disease, developed by Greek surgeon George Karydakis in the 1970s. It involves an asymmetric elliptical excision of the pilonidal sinus and surrounding tissue, followed by the creation of an advancement flap that moves the suture line away from the midline of the natal cleft.

The key insight behind the Karydakis procedure is that wounds placed in the midline of the natal cleft are under constant tension and in a moist environment, making them prone to breakdown and recurrence. By moving the closure off the midline, the Karydakis procedure creates a more favourable healing environment and achieves recurrence rates of less than 5% — significantly better than simple midline closure techniques.

How the Karydakis Procedure Works

The procedure begins with an asymmetric elliptical excision that removes the sinus and a margin of healthy tissue on one side of the midline. The deeper tissue is then mobilised to create an advancement flap, which is brought across the midline and sutured in place. This moves the entire wound to one side of the natal cleft, away from the pressure point at the midline.

The asymmetric design also reduces the depth of the natal cleft, which is a major contributing factor to pilonidal disease. A shallower cleft means less hair accumulation, less moisture, and less friction — all of which reduce the risk of recurrence.

Benefits of the Karydakis Flap

Less than 5% recurrence rate in published studies
Off-midline closure promotes faster, more reliable wound healing
Reduces natal cleft depth to prevent future disease
Well-established technique with decades of clinical evidence
Suitable for primary and recurrent pilonidal sinus
Relatively short recovery compared to other flap procedures

Step-by-Step Procedure

Anaesthesia

Performed under spinal or general anaesthesia for patient comfort.

Asymmetric Excision

An asymmetric elliptical incision is made, removing the sinus and a margin of tissue on one side of the midline.

Flap Mobilisation

The skin and subcutaneous tissue are mobilised to create an advancement flap.

Off-Midline Closure

The flap is advanced across the midline and sutured in place, moving the wound away from the pressure point.

Drain Placement

A suction drain is usually placed to prevent fluid accumulation and promote healing.

Dressing and Recovery

A protective dressing is applied. Most patients go home the next day.

Recovery Timeline

Day 1–2

Hospital stay for wound monitoring and drain management.

Week 1

Drain removed at follow-up. Wound care instructions provided. Avoid prolonged sitting.

Week 2

Most patients resume light activities and desk work.

Week 3–4

Increasing activity levels. Wound healing progresses well.

Week 6+

Full recovery. Return to exercise, sports, and all normal activities.

Cost of Karydakis Flap Surgery in Bangalore

The cost of Karydakis flap surgery in Bangalore typically ranges from ₹70,000 to ₹1,30,000 depending on complexity and hospital stay. Most health insurance plans cover this procedure. EMI options are available for 3, 6, and 12 months.

Frequently Asked Questions

Is the Karydakis procedure suitable for first-time pilonidal sinus?

Yes, the Karydakis procedure can be used for primary pilonidal sinus, but it is particularly recommended for recurrent cases or patients with a deep natal cleft.

What is the recurrence rate?

Published studies report recurrence rates of less than 5% with the Karydakis procedure, making it one of the most effective surgical options available.

How long does the surgery take?

The Karydakis procedure typically takes 60–90 minutes under anaesthesia.

Will I need a drain after surgery?

A suction drain is usually placed for 24–48 hours to prevent fluid accumulation and promote wound healing.

Dr Adarsh M Patil

Medical Reviewer

Chief Author & Medical Editor

Dr Adarsh M. Patil, MS, FMAS | Karnataka Medical Council Registration: 53728 | 25+ Years Experience

Last Reviewed: September 22, 2026

About the Medical Reviewer: Dr Adarsh M. Patil is a Bengaluru-based surgeon with a focus on pilonidal sinus care. Pages that carry this panel are reviewed for patient-facing clarity and are updated when clinical information changes. Website information supports, but never replaces, an individual consultation.

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The information on this website is for patient education and does not replace an individual medical assessment, diagnosis, or treatment plan. Pages carrying a medical reviewer panel are reviewed by Dr Adarsh M. Patil for patient-facing clarity.

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Medical reviewer: Dr Adarsh M. Patil, MS, FMAS | KMC Registration: 53728 | Last Updated: September 22, 2026