Sacrococcygeal pilonidal disease is an inflammatory condition that typically affects young adults and has a high prevalence rate (25 cases per 100,000 people). Unfortunately, the most effective surgical procedure for curing this illness has yet to be identified. This research aimed to evaluate the effectiveness of the unroofing curettage technique versus the modified Limberg flap. This investigation utilizes a historical cohort design. Between 2013 and 2017, 2 surgeons performed the procedures. Surgical outcomes for 278 patients with the pilonidal disease were evaluated. Both types of anesthesia were used for the unroofing curettage procedure, but spinal was the only option for the modified Limberg flap. The rate of recurrence was the primary measure of effectiveness. Secondary outcomes included side effects, activity restrictions, and recovery time. After a median follow-up of 60 months, there was a non-significant difference in recurrence rates between the unroofing curettage and modified Limberg flap groups (1.5% vs. 4.2%, P=0.45). The unroofing curettage group had a shorter surgery time and hospital stay (11.44 ± 3.56 minutes vs. 52.47 ± 7.92 minutes and 0.27 ± 0.45 days vs. 1.07 ± 0.26 days, respectively; P<0.001). The modified Limberg flap group experienced significantly more postoperative complications (9.8% vs. 2.2%, P=0.009). When comparing the 2 groups, those who underwent unroofing curettage had a significantly shorter recovery time (8.6 ±7.8 days vs. 25.01 ± 6.3 days, P<0.001). Complete healing took significantly longer (35.3 ± 9.2 days vs. 23.2 ± 5.4 days, P<0.001) in the unroofing curettage group. This investigation’s limitations can be traced back to its retrospective nature. Clinically, the unroofing curettage approach fared better than the modified Limberg flap method. Surgical treatment of pilonidal disease should initially involve unroofing curettage.