Objective: Cleft lift technique was performed in patients with chronic or recurrent pilonidal sinus (PS). It has been reported to provide better results than simple excision  and closure in the midline. The aim of this retrospective study was to evaluate the results after introducing the tension-free flap as asymmetric cleft lift procedure in our hospital on a day care basis. Patients  and  methods:  Between  June  2008  and July  2011, 236  patients  (199  males,  37 females: median age 30 years; range, 18-46 years) underwent excision ofthe pilonidal sinus with tension-free primary closure in cleft lift technique. Patients were observed and followed up (126 cases (53.3%) of these patients accepted a consultation  in the outpatient clinic w hile 75 cases (31.7%) were interviewed  by phone) for the healing rate and reporting the postoperative criteria over 2 years. Results: At follow up mean 24 (range 10--27) months after the operation,  169 (72.6%)  of the wounds were healed while recurrences were present in 32 (13.5%)  of the patients. Further results related to pre-, per- and postoperative conditions are discussed in this paper. Conclusion:  Cleft  lift procedure results in  a similar looking  wound of the midline and a shallow cleft. It is very successful in the treatment of difficult recurrent sinuses, where the early results are promising.