Aim: A pilonidal sinus refers to a tract or cavity under the skin that contain hair. The most common areas are 
in the sacrococcigeal (tailbone) area and the umbilicus.In spite of different treatment modalities there is no 
surgical procedure satisfies the principal, requirement an ideal treatment.
Objective To evaluate and compare between excision with primary closure of the wound and excision with 
Rhomboid flap reconstruction in the treatment of pilonidal sinus as regard duration of operation, healing 
time, hospital stay, complications and recurrence rate.
Methods: This study was conducted in general surgery department at Mansoura university hospital during 
the period from April 2008 to March 2010, 140 consecutive patients were treated (131 men and 9 women) the 
patients were randomized into two groups: group I underwent Rhomboid flap procedure; group II 
underwent excision and primary closure. The post operative follow up ranged from 8 month to two years 
(Mean Period was 18 months).
Results: Duration of operation was shorter in group I (P=0.69), hospital stay was longer in group II (P=.009),
return to work was faster in group I(P=0.001), postoperative complications were higher in group II (P=0.012) 
and recurrence rate was lower in group I (P=0.14).
Conclusion: Excision and rhomboid flap is better than excision and primary repair in treatment of pilonidal 
disease because it flattens the natal cleft, avoid dead space, healing time is short, morbidity is low, shorter 
hospital stay and low rate of recurrence.