Background and objective: Umbilical sinus develops either in an abnormal embryonal remnant of Omphalomesenteric & Urachal ducts, or secondary to hair insertion in the umbilical skin with resultant suppuration ending in what is named umbilical pilonidal sinus.This study viewed the relative distribution of these pathologic variants and results of management options adopted. Methods: All patients (n=28) suffering from umbilical sinus disease during the period of 5 years, between 1st Jan 2015 to 31st Dec 2019 are evaluated according to their pathologic types and therapeutic options. For hair sinuses, the conservative approach was initiated, its failure demanded exploration without excision. For sinuses secondary to embryonal remnants, the treatment was complete tract excision. Results: Umbilical pilonidal sinus constitutes the majority of sinuses in the umbilicus (n=26) (92.86%), suppuration in Embryonal remnants was far less common (n=2) (7.14%). The conservative management was effective in 24 (92.3%) out of 26 patients who were presented with umbilical pilonidal sinus, two patients got recurrence (7.14%), and necessitated tract exploration. Sinuses secondary to embryonal remnants (7.14%), were dealt with complete tract excision. In the results also; umbilical pilonidal sinuses were associated with young age group, (78.57% were between 21 and 30 years of age), male gender (85.71%) and overweight, (60.71%). Conclusion: The conservative approach was successful in the majority of cases, failure was mainly due to incomplete hair removal, for such cases a valid alternative was sinus exploration. Sinus tract excisions were spared for sinuses secondary to Omphalomesenteric & Urachal sinuses.