After excision of pilonidal sinus treatment consists either in open procedure or primary closure. We present the results of 45 consecutive patients (male 29, female 16, age 32 +/- 13 years), who underwent surgery between September 2001 and December 2002. Fourteen patients had simple fistula without infection, 18 had fistulas with putride secretion and 13 had abscess. Primary closure with direct suture was performed in 34 patients (76 %: 13 x simple fistula, 13 x fistula with putride secretion, 8 x abscess). Eleven patients were treated by layopen procedure and secondary wound healing. Wound infection occurred in 13 patients (7 x superficial, 6 x deep). Mean time of postoperative treatment was 15 +/- 3 days after closure and primary healing and 66 +/- 15 days after open proce dure or secondary healing. Mean time out of work was 19 +/- 10 respectively 52 +/- 19 days. A recurrence of fistula occurred in eight patients after primary closure (18 %) and none after open procedure. Also in cases of pilonidal sinus with infection, primary wound closure can be carried out even though the rate of recurrences is higher than after open procedure. A successful primary closure significantly reduces time of illness and time out of work.