<b>Comparative Evaluation of Postoperative Complications Following Karydakis Versus Limberg Flap Procedures for Pilonidal Sinus Disease: A Retrospective Study</b>

Background: Pilonidal sinus disease is a chronic inflammatory condition of the sacrococcygeal region that frequently requires surgical treatment. Although Karydakis and Limberg procedures are widely used, the optimal technique remains debated because postoperative recovery and wound complication profiles vary across settings. Objective: To compare postoperative complications and recovery outcomes following Karydakis and Limberg procedures for pilonidal sinus disease. Methods: This retrospective comparative observational study included 78 patients who underwent pilonidal sinus surgery at Chaudhry Hospital, Lahore. Patients were categorized according to surgical procedure: Karydakis procedure (n=43) or Limberg flap procedure (n=35). Baseline characteristics, recovery outcomes, and postoperative complications were extracted from medical records and operative notes. Categorical variables were compared using appropriate statistical tests, with p≤0.05 considered statistically significant. Results: The Karydakis group had significantly shorter hospital stay (p=0.039), earlier drain removal (p<0.001), and earlier return to daily activities (p=0.018). However, wound infection was higher after Karydakis surgery than after Limberg flap surgery (41.9% vs 17.1%; OR=3.48, 95% CI 1.20–10.12; p=0.019), as were wound dehiscence (34.9% vs 5.7%; OR=8.84, 95% CI 1.86–42.02; p=0.002) and edema (41.9% vs 20.0%; OR=2.88, 95% CI 1.03–8.04; p=0.040). Hematoma and pain were not significantly different. Conclusion: Karydakis surgery showed faster recovery, whereas Limberg flap surgery demonstrated fewer wound-related complications.