Background: Sacrococcygeal pilonidal sinus disease (PSD) is notorious for prolonged morbidity and recurrence. Mild pain, shorter hospitalization, mild risk of complications, early return to routine activities, better cosmesis, and minimal recurrence rate are the suggested criteria of ideal treatment of PSD. In Limberg flap technique, flattening of the intergluteal cleft is flattened, and the scar is placed away from the midline. This eliminates the causative factors of PSD. However, the drawbacks of this procedure are necrosis of flap at its vertex and maceration of skin at the incision site. This study aimed to perform tear-drop-shaped excision and reconstruction with modified Limberg transposition flap technique among patients for PSD at the sacrococcygeal region and discuss the clinical results. Materials and Methods: Eleven patients with primary sacrococcygeal PSD were included in the study between September 2017 and September 2018 at the JNMC, Wardha, Maharastra, India. It was planned for each case to undergo tear-drop-shaped resection and reconstruction with a modified Limberg transposition flap with a suction drain. Drains were removed after 48 h. Results: The mean age of the patient was 28.2 ± 8.4 years. All were male with a mean duration of symptoms of 3.8 ± 1.3 years. The mean operative time was 84 ± 23 min. Primary healing was obtained in all patients. Stitch was removed on the 14th postoperative day. The average hospital stay was 10 days as 2/3rd patients wanted discharge after stitch removal. The mean time to resume work was 22.6 ± 7.2 days. The mean follow-up period was 18 ± 6 months without any documented recurrence except hypoesthesia on the flap among two cases. Conclusions: More cases are required to conclude better methods among the two procedures of tear-drop-shaped modified Limberg flap and classical Limberg flap.