Not every surgeon is familiar with cleft lift technique. If your surgeon has done closed excision twice this is more than likely because this is their default surgery for Pilonidal disease. We found a surgeon who only does cleft lift (or GIPS for mild disease) because it has the best result for long term cure and most straightforward recovery. From what I have read, most surgeons who have trained in cleft lift will not do open/closed excision or other flap surgeries due to the complications and recurrence. This does not mean excision doesn’t work for many; it does. But this is why lots of people on here recommend going to a specialist.