Background: Pilonidal sinus disease is a chronic inflammation and infection of the sacrococcygeal region, it is a common disease, affecting roughly 26 per 100 000 population, usually appears at age between 15&25 years old and predominantly affects young males. It can cause pain, sepsis, and reduced quality of life and has an impact on the individual's ability to attend work or education. Risk factors for the condition include male gender, young age, obesity, hairiness, deep natal cleft, and poor hygiene. Aim of Study:To conduct a systematic review and metaanalysis for studies comparing between excision of pilonidal sinus and lay open versus primary closure and between karydakis technique versus limberg technique regarding wound healing. wound complications, and recurrence rate. Material and Methods:We have performed an electronic search for PubMed, Cochrane library, Google Scholar, resulting in 334 studies filtered for title and abstract resulting in 152 studies eligible for full text search, then second filter was done for full text excluding 128 unrelated studies and 24 studies were obtained, 9 studies compared between lay open and primary closure technique & 15 studies comparing karydakis technique and limberg technique.Results: Complication rate was 16.41% in lay open group, 22.55% with primary closure group and it was 15.45% with Karydakis flap and about 20% with limberg flap. Recurrence rate was 8.91% after lay open, 6.83% after primary closure, 3.09% after Karydakis flap and 4.89% after limberg flap. Conclusion:Lay open procedure was associated with shorter operative time and reduced risk of recurrence or complication rate in comparison to primary closure technique, but it take more time for hospital stay and wound healing. Also, Karydakis technique was associated with shorter operative time, shorter hospital stays, lower need to resuture, higher satisfaction with no significant difference regarding complication and recurrence rate. So, it was recommended to use karydakis technique in routine clinical practice.