Introduction Pilonidal sinus (PNS) disease is distributed in young adults who are supposed to be healthy with maximum productivity. Wide local excision creates a tissue gap, while the concept of minimal excision preserves healthy tissues with minimal tissue gap. Objectives The aim of the study was to evaluate the efficiency of minimal excision technique after 9 years of experience. Patients and methods This retrospective study involved 205 consecutive patients with sacrococcygeal PNS. All patients were treated surgically with minimal excision and primary closure. Follow-up included wound seroma, infection, or disruption, in addition to sick leave and PNS recurrence. Results PNS minimal excision was performed on 205 patients. The mean operative time was 33 min. The hospital stay ranged from 7 to 12h. Healing time was 12–22 days. Time to remove the drain 4–7 days. Seroma developed in 4.39%, simple wound infection 6.8%, significant wound infection 2.9%, and recurrence in 1.46%. Patients with recurrence shared the criteria of being obese with deep clefts and poor hygiene. Conclusion Minimal excision and primary closure is a safe and easy operative procedure, applicable to primary, recurrent, and complex branched cases with good results in
wound healing and low recurrence rate.