Background: Pilonidal sinus is a common infectious process which occurs in buttocks and sacral area which involves a wide range of symptoms that are different from an asymptomatic sinus to acute and chronic sinus track. Aim of the work: The aim of the study was to evaluate the outcome of modified Limberg transposition flap in surgical reconstruction after excision of pilonidal sinus. Patients and Methods: This prospective study was conducted at the Department of General Surgery, Al-Azhar University Hospitals (Al-Hussin & Sayed Galal hospitals). This study was carried out on 30 consecutive patients with primary non recurrent sacrococcygeal pilonidal sinus from 11/2018 to 6/2019 to allow a minimum follow-up period of at least 5 months for the last case operated upon. Results: Operative time and postoperative pain with mean operative time 47.37 ± 5.67, postoperative pain: 18 patients (60%) with mid pain, 10 patients (33.3%) with moderate pain, only 2 (6.7%) with severe pain. The complications among study group were 4 patients (13.3%) with wound seroma, 3 patients (10%) with wound hematoma, 3 patients (10%) with wound infection, 2 patients (6.7%) with wound gapping, only one patient (3.3%) with flap necrosis. The mean time for wound healing is 20.57 ± 5.72, 17 patients (56.7%) less than 20 days and 13 patients (43.3 %) more than 20 days, mean hospital stay is 3.63 ± 0.85, 17 patients (56.7%) = 3 days hospital stay and 13 patients (43.3%) more than 3 days hospital stay. Conclusion: Surgical reconstruction after excision of pilonidal sinus with modified Limberg transposition flap is an effective method for the management of pilonidal disease, especially when dealing with recurrent pilonidal sinus.