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No consensus exists on the optimal treatment for pilonidal sinus disease (PSD). Treatment with fibrin glue represents a novel minimally-invasive option.Forty consecutive patients with PSD were randomized to either fibrin glue treatment (FGT) or Bascom'sprocedure. End points included infection rates, QoL scores, analgesic requirements, convalescence and long-term recurrence.Pain and analgesic use were significantly reduced on days 1 and 7 in the FGT group (both P < 0.05). Normal mobility was achieved in 19/20 of FGT patients by day 7 vs 5/19 of those randomised to surgery, remaining statistically significant at week 6. The FGT group returned to work on average 7.2 days post-operatively compared to 42 days in the Bascom's group. Higher QoL scores in the FGT group at day 7 were sustained through week 6 (P < 0.05). There was no significant difference in wound infections or recurrence at a median of 4.6 years. significant direct cost reductions were achieved in the fibrin glue group.Fibrin glue is an effective treatment for PSD, with improved patient centred outcomes and long-term recurrence no different from surgery in this small group. Fibrin glue should be considered as an alternative to conventional surgical techniques in suitable cases.