OBJECTIVE: The success of surgical treatment of pilonidal sinus disease is measured by parameters such as recovery time, return time to daily activities, analgesic need, and complication and recurrence rates. We compared the rates of surgery, analgesic need, daily life return times, patient satisfaction, and complication and recurrence rates of patients treated with laser ablation to those treated with the Limberg flap (LF) technique. STUDY DESIGN: Between January 2017 and January 2019, 200 patients diagnosed with primary pilonidal sinus were randomized into 2 groups: LF surgery (n= 100) and pilonidal sinus tract ablation therapy (PiLaT) with a 1,470-nm diode laser (n=100). RESULTS: Average surgery time was 17.4±1.9 (14–21) minutes in the PiLaT group and 33.4±6.5 (28–40) minutes in the LF group. Duration of surgery was noticeably shorter in the PiLaT group (p<0.001). After surgery the early visual analog scale pain score was 2.4±0.5 (1–4) in the PiLaT group and 5.3±1.4 (3–6) in the LF group (p<0.001). The average time to return to daily activities was significantly shorter in the PiLaT group, with an average of 2.3±0.5 (1–4) days in the PiLaT group and 11.5±1.3 (8–15) days in the LF group (p<0.000). The satisfaction score was 4.4±0.6 in the PiLaT group and 3.2±0.8 in the LF group (p<0.001). CONCLUSION: If a disease is to be treated surgically, pain and tissue loss should be kept as low as possible. For this reason we believe that the PiLaT technique is an effective and reliable method that will be preferred by more patients and surgeons as the results of more controlled and comparative studies are reported. © Science Printers and Publishers, Inc.