Background The excision of the pilonidal sinus starts at 1833. Local, spinal, or general anesthetic procedures for the disease are widely used. The excision of the pilonidal sinus by using ligaSure reduces blood loss, reduces procedure time, and reduces patient length of stay. Therefore, the purpose of this study is to compare between local anesthesia and saddle block on the excision of the pilonidal sinus by using ligaSure, with respect to recovery time, postoperative complications, and patient satisfaction. Results Forty patients were analyzed; the mean time of anesthesia, operation time, and operating room time were showing highly significantly lower in group LA when compared to group SA (P value < 0.01). At the postoperative period, patients in group LA experienced less intense postoperative pain with prolonged time of the first request for analgesia than patients in other groups. Conclusion Local anesthesia has more efficacy in early start of anesthesia, early discharge from the hospital with prolonged analgesia, strong hemostasis, more patient satisfaction, and more than saddle block .Therefore, local anesthesia is considered as an alternative to the saddle block on the excision of the pilonidal sinus by using ligaSure.