Definitive emergency surgical treatment of an acute pilonidal abscess by excision of the squamous epithelial sinus or sinuses with drainage of the abscess has given excellent results. Although the procedure can be done in the office, it is best carried out in the hospital operating room with the use of local anesthetics. The great advantage of this method is that only one surgical procedure is required and the morbidity usually associated with this disease is lessened. The abscess has not recurred in patients so treated. The hospital cost is low, and the patient loses a minimal amount of time from work or school.