A personal series of 162 patients with chronic pilonidal disease was treated by rhombic excision and Limberg transposition flap. Each sinus was totally excised and covered primarily by a fasciocutaneous Limberg flap. Full primary healing was obtained in 161 out of 162 patients. One patient had ischaemia which resulted in necrosis of the flap tips that healed later with a scar. Minor infection occurred in 12 patients (7%). The average hospital stay was 4.2 days, and no patient remained in hospital more than 12 days. The mean follow-up period was 18 months, and three recurrences (2%) have occurred. Surgery for pilonidal sinus should not only eradicate the presenting sinus formation but should also aim to eliminate factors that predispose to formation of another sinus. This can be achieved using a Limberg flap which reduces the depth of the cleft and ensures that all parts of the wound and all suture holes are away from the midline.