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Recurrence Rates Following Excision of Hidradenitis Suppurativa: A Systematic Review and Meta-analysis.

BACKGROUND
Surgery is considered to be the best treatment for recurrent hidradenitis suppurativa (HS). Varying recurrence rates have been reported in the literature.


OBJECTIVE
To provide an up-to-date systematic review of the complete literature for different excision strategies and their recurrence rates in HS.


METHODS
A systematic literature search of the complete available literature and a meta-analysis of proportions were performed on the included studies.


RESULTS
Of a total of 1,593 retrieved articles, 125 were included in the analysis. Most of these studies were retrospective with 8 prospective analyses and one randomized controlled trial (RCT). The techniques described were divided into partial excision (PE) and wide excision (WE), described in 33 and 97 included studies, respectively. The average estimated recurrences were 26.0% (95% confidence interval [CI], 16.0%-37.0%) for PE and 5.0% (95% CI, 3.0%-9.0%) for WE (p < .01). Female sex (p = .016) and HS caudal of the umbilicus (p = .001) were significantly associated with the overall recurrence rate. Quality of evidence was poor, and the reporting of results was mostly heterogeneous.


CONCLUSION
This systematic review showed higher recurrence rates when it was not intended to resect affected HS tissue with a radical margin. There is a need for more RCT's and uniformly reported treatment outcomes.