Background: Pilonidal disease is a type of skin infection which typically occurs as a cyst between the cheeks of the buttocks and often at the upper end. Sacrococcygeal pilonidal sinus is a common disorder among young adults, observed most commonly in people aged 15-30 years with a 3:1 male-to-female ratio. Objective: To evaluate the role of vacuum therapy in pilonidal sinus disease compared with standard open wound care after surgical excision. Patients and Methods: This was a prospective study conducted on 50 patients who were candidates for surgical excision of pilonidal sinus at Al-Azhar University Hospitals during the period from January 2019 to December 2019. Patients were classified into two equal groups: Group A were subjected to the conventional open surgical method without suturing of the wound, and Group 2were subjected to closed surgical excision with putting a vaccum system. Results: Our results revealed a significant elongation in the operative time in vacuum group than in open ordinary method. In our study, the infection of the wound was more common in group A "ordinary open method" than the vacuum group "group B". Also, the recurrence rate after three months of follow up of cases was more common in group A than in group B. The time needed for complete healing in group B was shorter than in group A. Our study showed a significant decrease in frequency of dressing, and a significant patient satisfaction as well as early regain of normal daily activity in group B than in group A. Conclusion: The use of vacuum assisted closure (VAC) therapy in cases of pilonidal disease has its advantageous effect in decreasing complications and accelerating healing.