Surgical Approach to Extensive Hidradenitis Suppurativa in the Perineal/Perianal and Gluteal Regions

Abstract

Conservative treatment methods have little or no effect on extensive perineal/perianal hidradenitis suppurativa. Therefore, total surgical excision must be considered for these patients to prevent further complications, such as abscess, sinus tract formation, fistulization, and scarring. A temporary stoma may be needed in some cases. Because wound management after total excision is performed via different methods according to each individual patient, multidisciplinary team work is necessary and the patients often require a long hospital stay. If the treatment is not performed in an appropriate manner or if the patients are not followed closely until definitive healing, recurrence is almost inevitable. Despite the low incidence of accompanying squamous cell carcinoma, it is the most serious complication. We evaluated 15 patients to present our experience with extensive perineal/perianal and gluteal hidradenitis suppurativa.

Colocutaneous Fistula as a Result of Chronic Hidradenitis Suppurativa

“…The many known consequences of hidradenitis include psychological stress, lymphedema, fistulae, cancer, and even death [2,4,5,[7][8][9][10][11][12].…”

“…They treated patients with medically refractory hidradenitis and had no recurrences at their operative sites. While medical therapy should be first line treatment, surgical excision is the only curative option, and is often necessary in extensive disease [4,5,7,8,10].…”

“…Also, sinus tracts can form and drain purulent fluid [3]. It is well known that perianal fistulas can result from repeated flares [4,5]. There is also documentation of urethral fistula formation when inflammation occurs on the penis [6].…”

Hidradenitis Suppurativa

“…Thus, wide excision has been extensively demonstrated to offer patients the lowest chance of recurrence and therefore, the highest possibility of cure for HS, particularly when the disease is more severe 29,34]. While wide excision has been confidently shown to offer the best chance at a cure, the most superior method for closure is still under debate.…”

“…Though medical management may lead to symptomatic relief, studies have suggested that it is unlikely that these treatments change the natural course of HS [28][29][30]. There are several options for surgical management including incision and drainage, deroofing, local excision with primary closure, and wide excision techniques.…”