Efficacy and satisfaction of surgical treatment for hidradenitis suppurativa

Abstract

Background Surgery is a radical treatment for hidradenitis suppurativa (HS) and may be considered as the only one potentially curative. Objectives To characterize HS recurrence in patients after surgery and assess the risk factors of recurrence. Methods We conducted a monocentric retrospective cohort study. All consecutive patients who had surgery (January 1, 2012 to March 31, 2017) were included. We estimated the rate of recurrence of HS lesions after surgery (<1 cm from the scar), and recurrence‐associated factors were analysed by univariate then multivariate logistic regression, estimating odds ratios (ORs) and 95% confidence intervals (CIs). Results A total of 75 patients [median age 31.4 years (range 16–71); 36 females], corresponding to 115 interventions were included. The Hurley score at surgery was III for 70 (60%) patients. In total, 61/115 (53%) interventions involved wide excision and 50 (43%) limited local excision. The localizations were axillary folds (n = 46; 40%), buttocks (n = 15, 13%), genital area (n = 13; 11%), perineal area (n = 12; 10%) and inguinal folds (n = 18; 16%). We observed 11 (10%) complications and 40 (35%) recurrences. On multivariate analysis, probability of recurrence was associated with only one‐stage surgical closure [OR 3.2 (95% CI 1.4–7.3), P = 0.005]. Overall, 44 (52%) patients were completely satisfied and 22 (26%) partially satisfied, and most (81%) considered the surgery the best treatment. Conclusions Hidradenitis suppurativa recurrence in our study was 35% and associated with one‐stage surgical closures, but two‐thirds of patients were satisfied with surgical treatment and would recommend surgery.

Hidradenitis suppurativa: A review of post-operative outcomes

“…A study by Ovadja et al 2 in The Netherlands, of 107 surgical interventions for HS for 54 patients, found a 32% recurrence rate after a median 30month follow-up period. The 8 week healing time of the current study is also comparable to the 6 weeks that Ovadja et al 2 reported and the 3.3 months reported by Fertitta et al 1 A systematic review by Bouazzi et al 3 found that, of 54 relevant articles on post-operative HS complications and recurrences, there was an overall mean complication rate of 24% and a mean recurrence rate of 20%. Due to the high rates of post-surgical recurrence for HS in the literature, a retrospective review of surgical treatment of HS 4 concluded that recurrence of HS should be viewed as a feature of the Figure 2 Recurrence rates following first, second and third surgery.…”

“…Despite the current recurrence rate seeming high at 30% after the initial surgery and 25% after the second surgery, these results are in keeping with similar studies from other countries. A retrospective cohort study in France by Fertitta et al 1 , of 75 patients, found a recurrence rate of 35% across a total of 115 surgeries for HS. A study by Ovadja et al 2 in The Netherlands, of 107 surgical interventions for HS for 54 patients, found a 32% recurrence rate after a median 30month follow-up period.…”

Office-Based Surgical Intervention for Hidradenitis Suppurativa (HS): A Focused Review for Dermatologists

“…The top three reported complications were infection (n = 13), postoperative bleeding (n = 10), and dehiscence (n = 7), and other reported complications included pain and contracture/stricture of scar, delayed wound healing, hypergranulation, decreased mobility, and hypertrophic scar. Three studies reported the complication rate by lesion number, with a 26.1% complication rate across lesions (96 of 367 lesions had a complication; 4 lesions were excluded from the complication analysis by one author [21]). The top three complications among these three studies included wound dehiscence (n = 58 lesions), infection (n = 8 lesions), and contracture (n = 7 lesions), and other reported complications included lymphedema and scar retraction.…”

Ultrasound: an indispensable tool to evaluate the outcome of surgical approaches in patients affected by hidradenitis suppurativa

“…Moreover, ultrasound can help in evaluating and differentiating the various types of fistulas and choosing whether to use surgery or medical therapy. 6 Fertitta et al 1 have retrospectively measured the satisfaction of patients undergoing surgery for hidradenitis: US will be fundamental in evaluating the degree of satisfaction of patients undergoing medical or surgical therapy in a proseptic way. A better staging obtained through ultrasound can, in fact, allow to achieve a better degree of satisfaction and also guarantee lower recurrence rates.…”

“…Skin and soft-tissue infections associated with Aeromonas species in French Guiana: an 11-year retrospective study Editor Aeromonas species are Gram-negative bacilli, commonly found in salted and fresh water, food and soil. 1 Skin and soft-tissue infections (SSTIs) are frequent 2 and have been reported in Australia, 1 Asia 3 and the Indian Ocean. 4 However, data from South America are scarce.…”