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The Karydakis procedure is one of the asymmetric flap techniques used in the treatment of sacrococcygeal pilonidal sinus disease. The procedure consists of an asymmetrical elliptical excision, mobilization of the flap from the median side of the wound, fixation of the base of the flap to the sacrococcygeal fascia, and suturing of its edge to the lateral one. A modification of the original technique consisting of unfixing the base of the flap to the sacrococcygeal fascia with the purpose of flattening the natal cleft has been applied and its results evaluated.The present study included 82 consecutive patients. Data concerning age, gender, body mass index, duration of complaint, findings at presentation, and previous surgical treatment were obtained. The modified technique was applied in all patients. The postoperative complications and hospital stay were recorded. Patients were followed up by physical examination to detect recurrence.The hospital stay was two days for all patients. Postoperative complications were encountered in six patients (7.3 percent). Wound infection was encountered in four patients (4.9 percent), and subcutaneous fluid collections were encountered in two patients (2.4 percent). No recurrences were encountered throughout the 20 ± 6.8 months mean follow-up duration.The low complication rate, short hospital stay, short healing time, high degree of patient satisfaction, and absence of recurrence render the present modified technique a viable option in the management of sacrococcygeal pilonidal sinus disease.