Surgical Interventions in Advanced Hidradenitis Suppurativa: A Systematic Review

Background: Hidradenitis suppurativa (HS) is a chronic, immune-mediated skin disorder affecting intertriginous areas, frequently leading to painful nodules, abscesses, sinus tracts, and scarring. In patients with moderate-to-severe disease (Hurley Stages II and III), surgical intervention is frequently required to achieve durable disease control. Objective: To compare and evaluate the surgical interventions employed in Hurley Stage II and III HS by evaluating recurrence rates, postoperative complications, and patient-centred outcomes across different operative modalities. Methods: A comprehensive search of MEDLINE and EMBASE identified studies reporting surgical outcomes in Hurley Stage II and III HS. English-language studies describing postoperative recurrence, complications, and patient-centred outcomes stratified by surgical intervention were included. Of 647 studies screened, 136 studies were included. Results: A total of 136 studies were included (5,646 procedures). Primary closure had the highest recurrence (38.0%) and complication rates (29.4%). Wide excision (n = 1923) showed moderate recurrence (17.2%) and the highest cosmetic dissatisfaction. Laser-assisted surgery had the lowest complication rate (2.2%) and recurrence rate (5.7%). Flaps and grafts showed higher complication rates but fewer recurrences than primary closure. Conclusion: Surgical outcomes in advanced HS vary by intervention. Primary closure is associated with the highest rates of recurrence and complications, while wide excision and laser-assisted surgery may offer improved disease control. These findings support individualized surgical planning in Stage II and III HS.