title: Surgery under general anaesthesia in severe hidradenitis suppurativa: a study of 363 primary operations in 113 patients.
abstract: BACKGROUND
  Treatment of hidradenitis suppurativa (HS) is a difficult undertaking, especially as there is no consensus on what surgical technique is preferred. At our centre severe HS (Hurley II/III) is operated under general anaesthesia, mostly with the STEEP procedure.
  
  
  OBJECTIVE
  To investigate characteristics, surgical outcomes and patient satisfaction of HS patients who underwent deroofing or STEEP under general anaesthesia.
  
  
  METHODS
  A clinical records-based retrospective analysis was conducted of all patients who had surgery under general anaesthesia between 1999 and 2013. Patient satisfaction was retrospectively investigated with questionnaires.
  
  
  RESULTS
  A total of 482 operations (363 primary operations and 119 re-operations) were performed during the study period. The proportion of women in the included population was 68%. The median diagnostic delay (patient's and doctor's delay) was 6.5 years. Relapses occurred after 29.2% of primary operations. Women had higher relapse rates than men [odds ratio 2.85 (1.07;7.61)]. Hypergranulation of the wound was the most common complication and occurred in 7% of all operations. The median score patients attributed to the medical effect of surgery was eight of 10 (zero corresponding to very dissatisfied and 10 to very satisfied).
  
  
  CONCLUSIONS
  The diagnostic delay in HS is long due to a lack of knowledge in both patients and health care professionals, indicating that there is a need for education. Deroofing and the STEEP are effective surgical procedures in severe cases of HS and lead to a relatively high patient satisfaction. The postoperative relapse risk is higher in women. Prospective studies are required for the development of clear guidelines on the appropriate choice of surgery.
authors.affiliation: Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: J L
authors.initials: JL
authors.lastname: Blok
authors.affiliation: Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Boersma
authors.affiliation: Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: J B
authors.initials: JB
authors.lastname: Terra
authors.affiliation: Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: J R
authors.initials: JR
authors.lastname: Spoo
authors.affiliation: Department of Dermatology, Antonius Hospital, Sneek, The Netherlands.
authors.forename: F W J
authors.initials: FW
authors.lastname: Leeman
authors.affiliation: Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: E R
authors.initials: ER
authors.lastname: van den Heuvel
authors.affiliation: Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Huizinga
authors.affiliation: Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: M F
authors.initials: MF
authors.lastname: Jonkman
authors.affiliation: Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: Horváth
mesh_terms: D000293:Adolescent; D000328:Adult; D000768:Anesthesia, General; D005260:Female; D017497:Hidradenitis Suppurativa / Q000601:surgery*; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult