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Background: There are controversies about the etiology and management of recurrent pilonidal sinus. The numbers of techniques are testament in treating pilonidal sinus (PNS) and no single procedure is superior in all aspects. Aim of the study: The aim of this study was to compare two operative procedures (modified Limberg flap versus Z plasty flap) in management of recurrent pilonidal sinus, regarding their complications including recurrences of the disease, morbidity, hospital stay, day off work and postoperative complications.Patients and methods: This is comparative prospective study between modified Limberg flap and Z plasty flap in treatment of recurrent pilonidal sinus. 30 patients were divided into 2 groups: Group (1) treated with modified Limberg flap and group (2) treated with Z plasty, and we followed up the patients in both groups for postoperative complications, hospital stay, day off work, recurrences, patients satisfactions. Results: Operative time, hospital stay duration, complete wound healing was longer in group (2) Z plasty group. Mobilization was early in MLF group than Z plasty group (1 day versus 2 days). Time to return to work, it was 14 (12 -16) days in MLF groups and 18 (15 -22) in Z plasty group (p < 0.001). Infection occurred only in one in MLF group (1) and 2 patients in Z plasty group (2). The mean time for complete healing of the wound after Modified Limberg flap group (1) was 16 ± 4.2 days while in Z plasty group (2) it was 22 ± 6.8 days. Satisfaction score was better in MLF group (1). Recurrence hadn't occurred in any of the patients included in this study during the follow-up period. Conclusion: Both of modified Limberg flap and Z-plasty technique are used to cause flattening of the natal cleft,

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