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Wide excision of pilonidal sinus with secondary healing is associated with a long time off work owing to high morbidity. Limited excision is an alternative approach. The long term results of this treatment is described in 202 patients between 2001 and 2009.Limited excision consisted of a selective removal of the sinus after outrlining the track with methylene blue.At a median follow up of 4.5 years the overall recurrence rate was 7%. The median time off work was 8 days and the median time to wound healing was 4 weeks. The percentage of limited excisions performed in local anaesthesia increased from 52% to 90%. Theproportion of patients treated as an outpatient increased from 63% to 90%.At a follow up of 4.5 years limited excision for pilonidal sinus in an outpatient setting under local anaesthesia resulted in a low recurrence rate and short time off work.