Background: Pilonidal sinus is a common condition. Different treatment options are available with pros and cons of each method. The standard treatment is not yet determined. 
Aim of the work: Comparing excision with primary closure to Limberg flap reconstruction in the treatment of sacrococcygeal pilonidal sinus.
Patients and Methods: The study included 120 patients who were divided into two equal groups [60 patients in each group]. All were assessed on the clinical basis and those who eligible were recruited. Patient demographic and other data related to the sinus characteristics were documented. Both groups were compared regarding operative data, postoperative variables [e.g., pain, duration of hospital stay, pain-free walking, return to work]. The recurrence rate in the first year is the primary outcome, while complications and other variables represent the secondary outcome.
Results: Operative time was significantly shorter in primary closure than Limberg flap [30.17 ± 3.67 vs. 52.07 ± 6.75 minutes]. Similarly, primary closure was associated with significantly shorter duration of hospital stay, days to return to work, time to walk pain-free and time to painless toilet seat. However, the recurrence rate was significantly among the primary closure than Limberg flap [20.0% vs. 1.7%]. Otherwise, both groups were comparable.
Conclusion: Although the direct postoperative outcome [early] seems to be favorable in primary closure, the recurrence rate is higher with this procedure with comparable rate of complications. Thus, Limberg flap is advocated for treatment of pilonidal sinus.