Background: Pilonidal sinus is a chronic disease of the sacrococcygeal region, commonly seen in young adults, and is characterized by midline pits in the natal cleft associated with hair. This study was conducted to evaluate the outcomes of the Limberg flap procedure in the treatment of primary pilonidal sinus, including postoperative complications, duration of hospital stay, and time to return to work. Methods: This prospective observational study at the Department of Colorectal Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh (July 2019–August 2020), included 18 adults with primary pilonidal sinus. Excluding acute abscess and recurrent cases, patients underwent Limberg flap surgery under spinal anesthesia. Demographic, clinical, and outcome data were recorded, with follow-up at 2 weeks, and 1st, 3rd, 6th, and 9th months. Data were analyzed using SPSS® 24. Results: Among 18 patients undergoing Limberg flap repair, mean age was 26.9 ± 5.2 years, 88.9% were male, and most had BMI 18.5–24.9 kg/m². Single external opening was present in 83.3%. Mean operative time was 88.8 ± 12.7 minutes, hospital stay 4.17 ± 0.7 days, drain removal 3.4 ± 0.7 days, suture removal 12.9 ± 1.7 days, and return to work 12.7 ± 1.8 days. Postoperative complications occurred in 5 patients (27.7%), with no recurrences. Four of 5 overweight patients developed complications (r = 0.93, p < 0.001). Conclusion: The Limberg flap is a safe and effective treatment for sacrococcygeal pilonidal sinus, offering low recurrence, minimal complications, and rapid recovery.