Pilonidal sinus, acute or chronic suppuration of the sacrococcygeal region, is a common benign disease. Its treatment, usually surgical, remains controversial, between wide excision and limited excision and between primary closure and secondary closure. On the basis of our experience and a review of the literature, we propose limited excision with immediate closure for non-infected operations and exposure with immediate resection for pilonidal abscesses. Regardless of the technique used, the morbidity is high, associated with a recurrence rate of between 5 and 40%.