Why HS
How a colorectal practice became an HS program.
After more than fifteen years treating perianal disease, the pattern became impossible to ignore. Patient after patient arrived with diagnoses of recurrent abscess, complex fistula, or pilonidal disease — and on examination, what they actually had was perianal hidradenitis suppurativa that had been missed for years.
Standard surgical approaches — repeated incision and drainage, fistulotomy, wide excision — were not just failing to resolve the disease. In many cases they were making it worse, scarring the anatomy and complicating the eventual definitive treatment.
The international HS literature was telling a different story. Follicle-directed laser therapy with prospective data behind it. Anatomic, follicle-respecting surgical techniques using CO₂ to follow the disease rather than block-excise it. Multidisciplinary protocols coordinating dermatology and surgery. The tools to do this work better existed; they were not part of the standard American surgical training that these patients were funneled into.
Building a dedicated HS program meant studying those protocols in depth, traveling to learn from the groups pioneering the work in Europe, integrating both laser modalities into the practice, and rebuilding the patient experience around what HS patients actually need: a real diagnosis, a multi-modality plan, an honest conversation about limits, and a clinician who has chosen to take this disease seriously.
HS patients deserve better than the system has been offering them. That is the entire reason for this program.