© 2016 The ASCRS.BACKGROUND: No single treatment yet exists for pilonidal disease that has a short healing time, good cosmetic results, and a low rate of recurrence. Phenol crystal application and diathermy ablation through an endoscope have been used for the treatment of pilonidal disease, but this cohort is the first one to combine them. OBJECTIVE: The purpose of this study was to examine the safety, effectiveness, and short-and long-term outcomes of crystalized phenol treatment combined with endoscopic pilonidal sinus treatment for pilonidal disease. DESIGN: This was a prospective cohort study. SETTINGS: Procedures were performed in 2 hospitals by the same surgeon between February and July 2014. PATIENTS: Twenty-three patients underwent surgical treatment for pilonidal disease. INTERVENTIONS: Under local anesthesia and sedation, all of the patients underwent a video-assisted diathermy ablation of the sinus cavity and the application of phenol crystals. MAIN OUTCOME MEASURES: Adverse events were recorded as a measure of safety and tolerability. Failure to heal and recurrence rate were documented and evaluated. RESULTS: Patients were discharged on the same day as surgery. There was no or minimal postoperative pain (mean visual analog scale score, 1.40 ± 0.95). Mean operation time was 20.43 ± 6.19 minutes, and the median return-to-work duration was 2.00 days (mean, 3.03 ± 2.95 d). Patients were followed-up for 18 to 24 months (mean, 22.00 ± 1.88 mo). No serious complications or rehospitalization were observed. No primary failure to heal or recurrence was observed. LIMITATIONS: This study did not include a control group with which to compare and consisted of a relatively small number of patients. CONCLUSIONS: Crystalized phenol treatment combined with endoscopic pilonidal sinus treatment was safe, tolerable, and achieved fast and durable healing with no recurrence over an average of 22 months of follow-up.