Background: Various surgical procedures are existing for the treatment of pilonidal sinus diseases (PSD), but the best surgical approach is still controversial. Minimally invasive surgical procedures become more popular than the sophisticated complex surgery. The aim of the study is to evaluate the efficacy of sinusectomy with primary closure (SPC) in primary or recurrent cases comparing to the excision and primary closure (EPC) technique. Material and Methods: This single-center retrospective cohort study was conducted with two cohort groups in which 351 patients with PSD underwent either SPC or EPC procedure. The two procedures were compared according to the presence of short term complications and recurrence of PSD. Results: Of the patients, 134 underwent PC surgery, and 217 underwent SPC surgery. The length of stay and the wound healing time were statistically significantly longer in the patients underwent PC surgery. The occurrence of the wound site infection and the abscess were statistically significantly higher in PC surgery; however, the seroma was statistically significantly more common in SPC group. The recurrence rate was 18.7% for EPC approach, and 5.5% for SPC. Conclusion: SPC is an efficient procedure for the treatment of patients with PSD have both simple and complicated disease patterns.