OBJECTIVE: Pilonidal sinus is one of the common diseases, although there is still no gold standard of treatment available. The aim of this study was to reduce the residual dead-space volume with a modification following the standard Karydakis procedure. METHODS: A total of 100 patients were included in a randomised controlled trial, who were divided into two groups. Each group included 50 patients, and the patients in Group-1 were treated with the new technique, whereas in Group2, the standard Karydakis technique was performed. In the new technique, following total sinus excision, an advancement tissue flap was performed using additional skin excision, in order to reduce the dead-space volume. RESULTS: There was no significant difference in terms of sex, age, and sinus volume. Operation time was longer in first group (p=0,002). Seroma formation rate was higher in the secound group (p=0.036). There was no significant difference in terms of soft tissue infection (p=0.339) and wound dehiscence (p=0.218). The mean follow-up period was 30 months and no recurrence was observed in both groups. CONCLUSIONS: The results of the study suggest that this technique may be considered as an alternative surgical method in pilonidal sinus surgery.