Abstract The flaps closure including natal cleft obliteration and eccentric closure are becoming more popular due to their lower rate of recurrence including both the lateral advancement adipo-fascio-cutaneous flap and the classic limberg flap. This study aimed to compare the results of the surgery for non-complicated pilonidal sinus with the lateral advancement adipo-fascio-cutaneous flap versus the classic Limberg flap. Patients and methods: This study was a prospective randomized controlled trial, and was conducted on patients with non-complicated pilonidal sinus attending Zagazig University Hospitals, Egypt during the period from February 2017 to August 2019. Patients were randomly assigned to undergo either lateral advancement flap (group A) or classic Limberg flap (group B). The follow-up period ranged from 12 to 36 months. Demographic characteristics, operative duration, hospital stay duration, patient satisfaction, complications and recurrence rates were analyzed and compared. Results: 101 (85 men and 16 women) patients (out of total 137 patients) were finally completed the study. Age of patients ranged from 18 to 42 years with a median age of 27.5 years in group (A), while in group (B) the age of patients ranged from 19 to 41 years with a median age of 27 years. There were no significant differences between the two groups in terms of length of hospital stay, complications rate, patient satisfaction, or recurrence rate. Conclusion: The lateral advancement adipo-fascio-cutaneous flap is as effective as the classic Limberg flap in the treatment of non- complicated pilonidal sinus with significant lower operative duration of the lateral advancement flap