Background Pilonidal sinus is a chronic inflammatory disease which is characterized by a granulomatous reaction to fragments of hair shaft penetrating epidermis from the cutaneous surface. This disease is well known in medical literature and has been described by Mayo in 1833 as a hair-containing cyst located just below the coccyx. Aim this study is a prospective study to evaluate a surgical technique for management of umbilical pilonidal sinus after failure of conservative management. Patients and Methods 25 patients with umbilical pilonidal sinus participated in this study. Conservative management for 8 weeks was applied for all patients. Surgery was done if conservative management failed. Surgical complications, patient satisfaction and recurrence rate were evaluated. Results: 8 patients were treated conservatively, 17 patients underwent surgical management after failure of conservative management. Minor surgical complications (seroma, hypraemia) occurred in 4 patients (23.5%). Major surgical complications (severe infection, flap necrosis) occurred in 3 patients (17.6%).11 Patients (64.7%) showed complete satisfaction after surgical treatment. No recurrence occurred after 6 months follow up. Conclusion surgical management of umbilical pilonidal sinus by the described surgical technique resulted in accepted satisfaction among patients with no recurrence in 6 months of follow up. Key words umbilical pilonidal sinus, umbilical excision, umbilical discharge.