Research Article

Surgical Approach to Extensive Hidradenitis Suppurativa in the Perineal / Peri-anal and Gluteal Regions

  • Emre Balık

Turk J Colorectal Dis 2007;17(1):27-32


Verneuil’s disease or peri-anal hidradenitis suppurativa (HS) is a chronic suppurative disease with a tendency to sinus formation, fibrosis and sclerosis. It is a disease of the apocrine sweat glands and may arise on each of the localizations where apocrine glands are prominent: axilla, nipples, umbilicus, perineum, groin and the buttocks. In this study, we present our experience on extensive hidradenitis suppurativa cases including our treatment methods and outcomes.


A retrospective review of ten patients medical records from January 1990 to July 2003.


Ten patients underwent treatment for hidradenitis suppurativa in the gluteal, perineal / peri-anal and inguinal areas with surgical excision. All patients were males (100%). The median age was calculated to be 42.5. All patients underwent a total number of 13 operations during their treatment periods. 6 patients wounds were left open for secondary healing and the mean time for complete wound healing was found to be 12.2 weeks in this group (9.5-22 weeks). Two patients underwent primary wound closure by the application of rotation flaps and their complete healing times were observed to be approximately 2 weeks. Delayed skin grafting was used for the remaining two patients in whom the wounds had been left open after the first operation. In this group complete wound healing took a total time period of two months. Only one diverting colostomy was performed that was in the delayed skin grafting group. Squamous cell carcinoma was diagnosed in the specimens of one patient treated with total excision and rotation flap. This patient had had complaints of gluteal discharge for about 30 years. The cancer recurred after 6 months in the peri-anal region and immediate abdominoperineal resection had to be performed. This patient died in the postoperative 2nd month due to systemic spread of the malignancy. At the end of a 5-year-median follow-up period, all remaining patients were determined to be disease free.


Conservative treatment methods have little or no effects in perineal / peri-anal hidradenitis suppurativa. Therefore surgical excision must be considered in the early stages of the disease to prevent further complications such as abscesses, sinus tract formations, fistulizations and scarring. The management of the wound following wide excision should be carried out via different methods according to each individual patient. Despite the low incidence, accompanying squamous cell carcinoma remains to be the most serious complication. The treatment of HS needs to be carried out by multidisciplinary team work and often requires long hospital stay. If the treatment is not performed in a radical manner or if the patients are not followed close enough until definitive healing, recurrence is almost inevitable.

Keywords: Hidradenitis suppurativa, perineal / peri-anal, gluteal, surgical treatment