We aimed to evaluate the perioperative findings and postoperative outcomes of patients with non-infected pilonidal sinus disease (PSD) undergoing Karydakis Flap (KF) or tension-free primary midline closure (TFPC). The medical data of 136 patients who were operated for non-infected pilonidal sinus disease (PSD) by a single surgeon between May 2017 and January 2021 were retrospectively analyzed. A total of 127 patients (mean age of 25.2 ± 6.2 years) were included in the study. There were no significant differences between groups in terms of gender, hematoma, wound dehiscence, infection, recurrence and lenght of hospital stay (p>0.05). The mean operative time was significantly longer for TFPC group than KF group (27.8 min vs. 35.9 min, p<0.05). Seroma rate was 35.3% in TFPC group, compared to 11.9% of KF group (p<0.05). TFPC method can be preferred as the first treatment for PSD, as it is an easy method and has long-term results similar to Karydakis flap procedures.