Complications of hidradenitis suppurativa after surgical management: A systematic review and meta‐analysis

Hidradenitis suppurativa (HS) is a chronic inflammatory disease that affects the apocrine glands in the axillary, groin, and breast regions, with apparent physiological and psychosocial sequelae. As many studies have reported, surgical management is one of the treatment options. A comprehensive systematic review of surgical treatment for HS is provided in this study. Literature retrieval was conducted on MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Infrastructure (CNKI) and clinical registries from their inception to 1 May 2022. The principles of the PRISMA were adhered to in the process of literature search and the reference lists of the articles retrieved were also checked for further reference. Heterogeneity was assessed in meta‐analysis by means of the Q‐test and I (2) index. A total of 13 studies were finally included which involved 535 participants in total. The average estimated complication rate was 11.1% (95% confidence interval [CI], 6.4%–16.9%). The meta‐analysis was conducted on pooled complication sample studies and pooled recurrence sample studies. The recurrence was 16.2% (95% CI, 9.1%–24.9%). Subgroup analysis revealed significant differences in HS complications among different closure types. Among different locations, the highest rate of 16.0% (95% CI, 6.8%–28.2%) was multiple locations. Besides, differences were also observed in diverse excision methods and the highest was deroofing 13.9% (95% CI, 2.2%–33.2%). Extensive resection, using skin flaps or skin grafts as a closure method, was associated with a higher incidence of complications. Providers should consider carefully the use of extensive resection or using skin flaps or skin grafts as a closure method so as to minimise the risk of adverse events.