Background The aim of this study was to report on the application of a minimally invasive technique to the radical extirpation of primary and recurrent pilonidal disease. This technique does not require specific equipments, is ordinarily performed under local anesthesia on an outpatient basis, and provides optimal cosmetic results. Methods A total of 187 patients including 68% of patients with previous pilonidal surgery and 12% cases of extensive disease underwent surgery as day case. The series was thus reviewed in terms of perioperative data, time off daily activities, time to complete wound healing, and recurrence. Results Overall, the incidence of postoperative complications was 9%, with 2% being the relative rate of >grade I complications. The median time off school/work was of 2 days, while the median time to complete wound healing was 35 days. At a median follow-up of 16 months, the overall rate of disease recurrence was 5, 6%. Conclusions This analysis demonstrates that minimally invasive pilonidal excision is an effective option for pilonidal disease, also in the case of recalcitrant or extensive disease.