Surgical Procedures

Updated: Feb 20

There are many options for treatment and management of HS, most of which include some type of surgery. Below are the most common types of surgical procedures used for HS. Please educate yourself and discuss options with your surgeon.

As you know, there is no cure for HS. HS is very personal disease and electing to have surgery is a personal decision. As with most things in life, there are no guarantees, but you don’t know if it will work for you unless you try.

For the best chance of success in treating your HS, start by finding a qualified plastic surgeon who has worked with several HS patients. No surgeon can perform a surgery without your written consent. If you don’t want a graft and your surgeon recommends it, tell him why you are electing not to have specific procedure done. You are not obligated to have surgery with a doctor you don’t feel comfortable with or confident in. It is imperative that you are your own advocate and educate yourself.

Surgery success has many measurements. You will hear people complain about surgery “failing”; please keep in mind there is usually a reason for failure that could include:

- They went to the wrong surgeon or a surgeon inexperienced with HS

- The surgeon may not have removed all of the disease, tunneling and scar tissue or they may not have gone deep enough or cut wide enough

- The surgeon may close the site and may trap in the disease, which does not give it time to completely drain out

If you're considering surgery be very careful of the negative stories. We’ve all heard people complain about surgery only find out that they had 10 years of relief; that is nothing to complain about!

Incision and Drainage (I & D) / Lancing:

This is an outpatient procedure and is not considered HS surgery. It is a temporary drainage and should be avoided. It should not be used as a treatment for HS and should only be done when other measures have failed and/or when cellulitis or infection is present. The patient is instructed to watch for signs of cellulitis or recollection of pus.

The patient or family is usually trained to change packing or arrange for the patient’s packing to be changed as necessary.

I & D of a perianal abscess may result in a chronic anal fistula and may require a fistulectomy by a surgeon; I & D should be avoided in this area.

De-Roofing (Unroofing):

This is an “up-scale I & D” and is usually done for people with Stage I and II (mild to moderate). De-roofing is a minimally invasive procedure where the ‘ROOF’ of an abscess/sinus tract is surgically removed and a cross-shaped incision is made over the abscess to open it. The pus and dead tissue are removed and then the cavity is filled with antiseptic-soaked packs. This is different from the wide excision surgeries and less invasive.

Wide Excision Surgery with 2nd Intent (left open to heal from the inside out):

A qualified surgeon (typically a plastic surgeon) removes the entire affected and diseased area, which includes all of the tunneling and scar tissue as deep as the disease, tunneling and scarring burrow. There is a low risk of infection during healing and this procedure has the lowest rate of recurrence.

Many HS suffers have had great success and years of relief with wide excision surgery.

CO2 Laser Surgery

CO2 laser surgery can be performed under local or general anesthesia. Typical healing is by 2nd intent (left open to heal from the inside out).

There are various different lasers used during the CO2 treatment procedure, all having different functions and targeting various different aspects without damaging the skin. The CO2 vaporizes the flesh.

Wide Excision with Primary Closure:

Closure is definitely not recommended as the disease can get trapped underneath and behind the incision and typically abscesses will start forming immediately after surgery at the surgery site. The stitches and/or staples typically open or tear open right after surgery. There is a higher risk for infection with this procedure and the recurrence rate is higher using this method.

Wide Excision Surgery with Skin Graft or Flap:

Note: It does not matter how deep or how large the surgery area is, skin grafts or flaps are NOT needed unless medically necessary, please discuss with your surgeon.

There are very specific medical circumstances (sometimes in the anal area or vagina area) where a graft or flap needed and are only for cosmetic reasons. Grafts or flaps are not ideal for HS patients. The drawbacks to this surgery include that the skin grafts or flap do not take, there is additional unnecessary surgery, longer recovery at donor site, higher high risk for secondary complications and a higher rate for recurrence as opposed to other methods.

Gland removal is not necessary and not needed unless tunneling has become severe enough that it is affecting your glands and it is necessary. HS is not considered a gland disease. There is no guarantee it will help your HS or boost your chances of success by getting your glands removed.

This is an awareness article for educational purposes

Written by Denise Panter-Fixsen

Edited by Brindley Kons

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