Table 3.

Recommendations for surgical treatment of HS

Which types of surgery may benefit patients with HS?
Case and cohort studies used variable definitions of recurrence and a wide range of follow‐up time and, therefore, cannot be compared.	Consensus (100%) 0% range 1–3 0% range 4–6 100% range 7–9
In acute situations, surgical incision and drainage of tense and painful abscesses, i.e. fluctuant lesions, may be performed. However, incision and drainage should not be considered as a sole treatment because recurrence is almost inevitable47, 48, 49, 50 (evidence level 4, grade of recommendation C).	Consensus (100%) 0% range 1–3 0% range 4–6 100% range 7–9
Surgical procedures, such as limited excision, deroofing and STEEP, can be used for solitary lesions of the disease. They could be performed for recurrent HS lesions at fixed locations or fistula/sinus tract formation in limited areas51 (evidence level 4, grade of recommendation C).	Consensus (100%) 0% range 1–3 0% range 4–6 100% range 7–9
Wide excision of the entire affected area, with removal of (non‐)inflamed sinuses, nodules and scar tissue, may be performed in Hurley stage III to prevent recurrence53, 54, 55 (evidence level 4, grade of recommendation C).	Consensus (96%) 0% range 1–3 4% range 4–6 96% range 7–9
Chronic HS lesions that have not shown any signs of inflammation for a prolonged period of time may be excised to prevent further recurrence56, 57 (evidence level 5, grade of recommendation D).	Consensus (78%) 7% range 1–3 15% range 4–6 78% range 7–9
Special attention should be paid to patients with perianal and/or perineal HS due to the possible existence of anal, urethral and vaginal fistulas and presence of squamous cell carcinoma47, 58 (evidence level 4, grade of recommendation C).	Consensus (92.6%) 3.7% range 1–3 3.7% range 4–6 92.6% range 7–9
CO2 ablative laser treatment is an effective alternative method to electrosurgical or cold steel techniques59, 60 (evidence level 4, grade of recommendation C).	Consensus (100%) 0% range 1–3 0% range 4–6 100% range 7–9
How should medical and surgical treatments be integrated?
There are no RCTs describing the combination of medical and surgical treatments	Consensus (92.6%) 3.7% range 1–3 3.7% range 4–6 92.6% range 7–9
Pre‐ and postoperative biologic therapy may lead to a lower recurrence rate and a longer disease‐free interval61, 62 (evidence level 4, grade of recommendation C).	Consensus (89%) 0% range 1–3 11% range 4–6 89% range 7–9
There is no current literature regarding adverse events when integrating biologic therapy and surgery in HS patients. Studies in other immune‐mediated diseases are insufficient to advise preoperative interruption of biologics (evidence level 5, grade of recommendation D).	Consensus (100%) 0% range 1–3 0% range 4–6 100% range 7–9
Adalimumab reduces the need for surgical procedures (incisions and drainage)29 (evidence level 2, grade of recommendation C).	Consensus (85.7%) 3.6% range 1–3 10.7% range 4–6 85.7% range 7–9