Pilonidal sinus disease is a common medical condition that accounts for almost 15% of anal suppurations with high morbidity. Its management is subject to many variations. In this study, a 25-year experience from 1984 to 2009 of treating pilonidal sinus disease is being reported. A total of 252 patients were included in the study. They were treated by phenol injection, excision and primary closure, or excision and packing. Data showed that excision with packing had the highest cure rate (85%), followed by excision and primary closure (65%), and then phenol (55%). As for the healing duration, the shortest was for excision and primary closure, followed by the phenol injection. However, excision and packing had the least recurrence rate (12%), compared to phenol and excision with primary closure 26.5% and 23%, respectively. The authors recommended excision and packing. However, hospital stay, missed days of work, recurrence rates, and the surgeon’s familiarity with the techniques were important factors in the choice of treatment modality.