For the radical surgical treatment of pilonidal cysts and fistulas, the authors suggest the excision "en bloc" of the complete pathological tissue and the primary closure, according to a procedure which considers not only a accurate surgical technique and a kind of dressing which avoids pressure and traction on the sutures, but also a s.t. antibiotic prophylaxis based on culture tests. This kind of approach in surgical treatment showed according to their experience, excellent immediate and long term results, causing slight inconvenience to patients, with a short recovery with regard to cases treated without primary closure.