Abstract: Pilonidal sinus is disease commonly affecting young hairy individuals. The disease causes recurring infection and has a high recurrence rate. Understanding the pathophysiology is essential for developing a treatment plan. A variety of techniques have been developed for treating pilonidal sinus. These range from minimally invasive to excisional techniques. However no single procedure can be considered as the gold standard of care. Proper preparation of the area followed by optimum choice of the procedure can help in reducing both local wound complications as well as recurrences.