Several surgical options can reduce the effect of HS symptoms, particularly for people with Hurley Stage 2 or 3 HS. Examples include incision and drainage, deroofing, excision, cryoinsufflation, and laser treatment.
For individuals with a more advanced or severe form of HS, surgery may be a better option to manage symptoms and reduce lesion recurrence.
This article discusses several types of surgical procedures for treating HS, as well as outcomes, recovery, and potential complications.
- the current state of the disease
- which site is affected
- condition severity
- the presence of co-occurring conditions
Doctors will also include
The Hurley Staging system is as follows:
- Stage 1: This stage features single or multiple abscesses without sinus tracts or scarring.
- Stage 2: There are recurring abscesses with scarring and sinus tracts, as well as multiple or single separate lesions.
- Stage 3: This stage features abscesses across an entire site or multiple connected sinus tracts.
Although surgical procedures can treat any stage of HS, people with severe stage 2 or stage 3 may experience more benefits from surgery than oral medication or topical treatments.
Incision and drainage is a simple procedure for treating individual lesions such as those found in Hurley Stage 1 of HS.
The primary goals of incision and drainage are to relieve symptoms caused by fluid buildup and to reduce the infection that can lead to sepsis.
Incision and drainage involves:
- a local anesthetic to the affected area
- an incision that allows the drainage of abscess fluid
- gauze packing of the abscess cavity
- daily gauze changes
Incision and drainage produces immediate relief from discomfort and pain but has a recurrence rate of
Deroofing involves the removal of the top and contents of a lesion while allowing its floor to remain intact. The wound is left open, so it can heal through a process called secondary intention.
A healthcare professional may use deroofing to treat stage 1 and 2 HS. It can treat persistent sinus tracts, abscesses, or nodules.
Deroofing has a lower recurrence rate than incision and drainage. A 2015 meta-analysis estimated the recurrence rate for deroofing to be
Deroofing appears to have high patient satisfaction rates. A 2022 article notes that
A healthcare professional can perform a local or wide excision.
Local excision involves removing the abscesses individually. This procedure is appropriate for Hurley Stage 1 HS. It helps to manage disease activity, but lesions often return in the same area.
Wide excision involves the removal of a larger area of tissue containing multiple lesions. Doctors use wide excision to treat HS at Hurley Stages 2 and 3 or HS that is chronic and advanced.
Wide excision aims to remove the entire area of disease activity to prevent further recurrences. Wide excising may also reduce the chance of the diseased area becoming cancerous.
This procedure has a recurrence rate as low as
Cryoinsufflation involves using a needle to inject liquid nitrogen directly into sinus tracts.
A 2022 article notes that this method was first described in 2014 to treat Hurley Stage 2 and 3 HS. The authors state that two people who received this treatment had satisfactory results.
Although more research is necessary to determine the success of cryoinsufflation compared with other procedures, it appears to be a viable option for any stage of HS.
The American Academy of Dermatology (AAD) notes that strong lasers can treat HS.
Laser treatments may result in HS remission for as long as 12 months, generating positive feedback from recipients.
However, it is a costly treatment, and insurance does not usually cover the procedure. It can also take 6 months to recover.
Surgical procedures for HS can conclude in several different ways. For example:
- secondary intention healing, in which doctors leave the surgical area open to heal through wound shrinkage and new tissue growth
- primary suture, which is effective for small wounds with enough surrounding lax skin
- skin graft, a versatile option for closing a wide surgical site
- flaps, which are areas of nearby skin moved over to cover an HS excision site.
However, complications can occur. A 2020 study consisting of 53 people found that only
HS surgical results are not always permanent. For example, incision and drainage has a quick recurrence of inflammation in the treated lesions, and local excising may not prevent new abscesses from appearing.
Recovery times for HS surgery can vary depending on the nature of the procedure.
The review also found that people were typically pain-free in 2–3 weeks after performing self-care.
Self-care can include wound management. For example, secondary intention healing after deroofing and wide excision requires wound care that covers:
- managing leaking fluid, infection risk, and pain
- maintaining a clean, moist wound through regular dressing changes
HS surgical recovery may also include additional supports such as hyperbaric oxygen therapy (HBOT). HBOT is when a person gets into a special chamber with higher-than-usual oxygen levels.
The AAD states that HBOT can help to heal wounds related to HS due to the increase in oxygen.
Surgery for HS can result in the following potential complications:
- nerve damage
- wound opening
- hematoma — clotted blood resulting from blood vessel damage
overgranulation— excess tissue filling the wound bed to create a raised surface area
HS surgery may also include other common surgical risks, such as scarring and bleeding.
Recurrence is common after HS surgery. Rather than viewing this as a complication or unsuccessful treatment, some
HS treatments may be eligible for some financial help, depending on the type of coverage a person has.
If a person has Medicare, the International Association of Hidradenitis Suppurativa Network recommends that a person adds Medigap and prescription drug plans to supplement their original Medicare coverage.
This may help cover more of the costs.
Recent changes to Medicaid may offer coverage for HS treatments.
Line 419 of Medicaid’s Prioritized List of Health Services shows medical and surgical therapy for moderate-to-severe HS as part of the list for planned implementation.
Line 514 of this list shows that mild HS is eligible for medical therapy only.
Free or low cost healthcare
The US Department of Health & Human Services has a web page that offers resources and advice for those who are looking for inexpensive healthcare.
Depending on a person’s location, there may be partial coverage available for some HS treatments.
HS surgery is one of several treatment options for this painful and chronic condition. The type of surgical treatment a dermatologist might recommend will depend on factors such as disease severity and the presence of co-occurring conditions.
Surgical treatments often have satisfactory outcomes. Recovery takes several months, but people trained in self-care often experience relief from pain in just a few weeks.
There may be some complications with surgical procedures and a high rate of HS recurrence.