Abstract Background: Pilonidal Sinus is a common suppurative dis-ease in young adults which presented usually between the ages of 15 to 30 and requires definitive surgical treatment mostly open wound technique in concomitant with LASER hair reduc-tion to avoid recurrence. Aim of Study: The objective of this study is to to identify the effect of total excision of the whole sinus tract with LASER hair reduction of sacrococcygeal region in management of pa-tients with pilonidal disease. Patients and Methods: 160 patient participants were in-cluded in this study who met the inclusion criteria. They visit-ed the surgery clinic in Al Jazeera Medical Complex, Riyadh, Saudi Arabia over a period of 18 months, from June 2022 to November 2023, the age was between 15 and 32 and the proce-dure was done by the surgical registrar and the medical nurse in a small operating room under local xylocaine infiltration. The procedure consisted of excision of the whole sinus with good hemostasis and the wound was left opened with gauze covering it with frequent dressing until complete healing with LASER ablation of the hair at the sacrococcygeal region for 80 patients only and the other 80 patients underwent for laser reduction. Results: The study showed that concomitant LASER re-moval of the hair and open surgery method under local anesthe-sia is highly successful in treating pilonidal sinus disease with low recurrence rate. Conclusion: Pilonidal sinus surgery can be done away from the general anesthesia risks with low cost and good results and LASER hair reduction reduces the recurrence rate.