Unsatisfactory postsurgical end results in the treatment of chronic pilonidal sinus disease caused by long term healing, pain, inconvenience and recurrences of the lesion still remain problem after various surgical techniques have been described and used. This study was designed to show results of several aspects of midline closure technique with respect for surgical complications, hospitalization length and recurrence. This study included 90 patients with pilonidal sinus treated by surgery with midline closure at the department of General surgery of Clinical Hospital Mostar between January 2004 and January 2009. The patients were divided in three groups considering the type of drainage used. Data collected retrospectively included demographics, positive diagnosis of chronic pilonidal sinus, operative technique, type of drainage, complications, hospital stay and recurrence of the disease. Mean hospital stay after excision and midline closure technique was 4.68 days Complication rate was 18/90 (20%). Infection occurred in 18 patients (20%), dehiscence occurred in 10 patients (11.1%). Mean recurrence rate during follow up period was 12/90 (13.3%); range, 24-84 months. There was no statistically significant difference among three groups in hospital stay length (p>0.05), in complication rate (χ(2)=1.66, p>0.05), nor in recurrence rate (χ(2)=1.91, p>0.05). Statistically significant difference was shown between complication rate among non drained and actively drained patients (χ(2)=1.11, p<0.05). Primary midline closure is not a satisfactory method in the treatment of chronic pilonidal sinus, especially without drainage, leading to numerous complications and high rate of recurrence.