Introduction: A pilonidal sinus(PNS) is an infected tract at the natal cleft under the skin between the buttocks. It is a common problem in primary care due to the high recurrence followingsurgery. The patient treated here had a recurrent pilonidal sinus after three previous surgeries. Methods: The patient was operated by excision of the tract and closure of the wound. Results: The wound healed in two stages as explained in the study. Conclusion: The possible reason for reccurrence was detected and it was managed. Healing was complete and follow up after one year revealed no recurrence.