Introduction:  Pilonidal sinus disease is a chronic inflammatory condition of the sacrococcygeal region that predominantly affects young adults and tends to recur regardless of the technique used for its surgical correction. Comparative data on commonly performed surgical modalities from Indian tertiary care settings remain limited. This study was undertaken to evaluate the clinical profile of patients with pilonidal sinus and to compare the outcomes of the Limberg flap, Z-plasty, and excision with lay-open technique in its surgical management.

Methods:  Seventy patients with pilonidal sinus disease who fulfilled the inclusion criteria were enrolled on accrual at a tertiary care teaching hospital. Demographic, clinical, intraoperative, and postoperative data were recorded, and patients were followed up for six weeks. Outcomes among the three surgical procedures were compared using the chi-square test for categorical variables and one-way ANOVA for continuous variables, with p < 0.05 taken as significant.

Results:  The mean age was 28.87 years (SD 4.21), with a marked male predominance (57 patients, 81.4%). Pain was the commonest presenting complaint (28, 40.0%) and Limberg flap was the most frequently performed procedure (28, 40.0%). It required a longer operative time and hospital stay than excision with lay-open technique (p < 0.001 and p = 0.011) and was associated with significantly faster wound healing and earlier return to normal activity (p < 0.001 and p = 0.003). Postoperative complications (20.0% overall) and recurrence (10.0% overall) did not differ significantly among the three procedures.