Objective: It is yet uncertain what the best course of treatment for Pilonidal Sinus Disease (PSD), a common inflammatory condition of the natal fissure which leads to complications, especially in children, is. Our goal was to provide long-term PSD surgery outcomes. Methods: Between May 2018 and April 2023, 146 patients who had their first surgery at Services Hospital Lahore for pilonidal sinus disease (PSD) underwent our review of their medical data. Out of these patients, 113 underwent either asymmetrical excision with local flap (AELF) or mini-invasive pit-picking surgery (PSS). Examining the outcomes of both of these groups was the major goal. Results: Comparing patients with pelvic floor dysfunction who received minimally invasive posterior pelvic floor repair (PPS) to those who underwent abdominal sacrocolpopexy (AELF), PPS patients had a greater success rate with day surgery, fewer postoperative problems, and shorter sick leave. However, at the initial postoperative follow-up appointment, the healing rates for both techniques were comparable. With a recurrence rate of 50.9% compared to 10.3% for AELF, a long-term follow-up after around 9.3 years revealed that the recurrence rate after PPS was much greater than after AELF. This shows that although PPS could be advantageous in the near term, recurrence rates are greater compared to AELF over the long run. Conclusions: Despite the elevated likelihood of occurrences in our study, PPS, a minimally invasive surgical technique frequently carried out under local anesthesia, is an appropriate choice for treating primary PSD, keeping in consideration that patient selection is a crucial factor to take into account. PPS may be beneficial for primary PSD with straightforward sinus forms. However, despite the startlingly slow recovery in our study, primary PSD with complicated sinus structures might gain from AELF. PSD is a highly diverse illness, and individuals have distinct risk factors, thus the surgeon must be skilled in a variety of surgical procedures. It is necessary to develop a categorization system to help surgeons choose the best surgical approach for each patient.