Sacrococcygeal pilonidal disease is a frustrating health problem that occurs at least two times as frequently in men as in women usually between the ages of 15 and 30 years with exceptional occurrence before puberty or after the age of 60 years. During the past years a wide variety of approaches have been developed for treating pilonidal disease ranging from conservative methods (simple opening, curettage, brushing, and phenol injection) to wide surgical excision. Lately, surgical procedures have changed in favor of the flap techniques as they effectively provide wide excision of the diseased tissues and obliteration of the natal cleft thus neutralizing the causative factors that lead to a vicious circle of infection and recurrence. The aim of the study was to compare the short-term results of modified Limberg flap transposition, a widely used technique in pilonidal sinus surgical treatment, with lateral advancement flap (LAF) transposition, a relatively less frequently used technique, from the point of view of operative time, wound complications, recurrence, and patient satisfaction regarding cosmetic appearance using visual analog scale in the first 12 months postoperatively. The study included 60 consecutive patients with chronic pilonidal sinus disease admitted to Alexandria Main University Hospital between January 2013 and June 2014. The current study has proved equivalence between the modified Limberg flap and LAF in terms of postoperative wound complications and late disease recurrence. On the other hand, the LAF has proven its superiority with a statistically significant shorter operative time and more accepted aesthetic results.