Pilonidal disease (PD) is a common chronic intermittent disorder of the sacrococcygeal region. Despite surgical therapy dating back more than one century, management remains controversial and recent reports have advocated different surgical approaches. A retrospective review was conducted of 129 patients who were treated for chronic PD in our institution during a five-year period, 1990 to 1994. Excision with primary closure was performed in 56 patients; 47 underwent open excision without closure, and 26 had marsupialization procedure. All were performed electively, with only minor complications. Complete healing was fastest in the primary closure group, despite a 14 percent postoperative wound infection rate. Recurrence rates of 11, 13, and 4 percent were found for primary closure, wide resection, and marsupialization procedures, respectively. There was no correlation among recurrence rate, postoperative infection, or prior surgery. Considering healing time, morbidity, and recurrence rate, we conclude that surgical treatment should be directed at either excision and primary closure or marsupialization. Wide excision with secondary healing should be performed only for grossly infected and complex cysts.