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Background: The management of hidradenitis suppurativa (HS) requires a multidisciplinary approach to ensure sustainable treatment results, especially in the advanced stages. Traditionally, deroofing and wide excision represented commonly employed surgical techniques. Due to the recurrent nature of HS, tissue preservation should be a relevant aspect of surgical management. The aim of this manuscript is to demonstrate the use of a diode laser for the management of different stages of HS, paying attention to tissue preservation. Methods: This is a technical manuscript demonstrating our technique for laser–assisted management of HS. A diode laser with a wavelength of 1470 nm was used for this indication. The depth of the sinus/tract dictates the amount of energy required. Our preference is to use 8 Watts for deep lesions and 5 Watts for shallow lesions. Results: The following 7 critical steps are important to achieve an optimal result with this technique: Drain all collections, minimize tissue damage, protect healthy skin, control risk factors, adopt a multidisciplinary approach, follow up closely, and be patient. Conclusion: Laser-based management of hidradenitis suppurativa is a promising surgical option in the multidisciplinary treatment of this difficult pathology. The minimally invasive nature of laser surgery, especially tissue preservation, is a strong argument for the role of this technique in the management of this chronic, recurrent condition. [ABSTRACT FROM AUTHOR]

Aim: The primary aim of the European Society of Coloproctology (ESCP) Guideline Development Group (GDG) was to produce high‐quality, evidence‐based guidelines for the management of cryptoglandular anal fistula with input from a multidisciplinary group and using transparent, reproducible methodology. Methods: Previously published methodology in guideline development by the ESCP has been replicated in this project. The guideline development process followed the requirements of the AGREE‐S tool kit. Six phases can be identified in the methodology. Phase one sets the scope of the guideline, which addresses the diagnostic and therapeutic management of perianal abscess and cryptoglandular anal fistula in adult patients presenting to secondary care. The target population for this guideline are healthcare practitioners in secondary care and patients interested in understanding the clinical evidence available for various surgical interventions for anal fistula. Phase two involved formulation of the GDG. The GDG consisted of 21 coloproctologists, three research fellows, a radiologist and a methodologist. Stakeholders were chosen for their clinical and academic involvement in the management of anal fistula as well as being representative of the geographical variation among the ESCP membership. Five patients were recruited from patient groups to review the draft guideline. These patients attended two virtual meetings to discuss the evidence and suggest amendments. In phase three, patient/population, intervention, comparison and outcomes questions were formulated by the GDG. The GDG ratified 250 questions and chose 45 for inclusion in the guideline. In phase four, critical and important outcomes were confirmed for inclusion. Important outcomes were pain and wound healing. Critical outcomes were fistula healing, fistula recurrence and incontinence. These outcomes formed part of the inclusion criteria for the literature search. In phase five, a literature search was performed of MEDLINE (Ovid), PubMed, Embase (Ovid) and the Cochrane Database of Systematic Reviews by eight teams of the GDG. Data were extracted and submitted for review by the GDG in a draft guideline. The most recent systematic reviews were prioritized for inclusion. Studies published since the most recent systematic review were included in our analysis by conducting a new meta‐analysis using Review manager. In phase six, recommendations were formulated, using grading of recommendations, assessment, development, and evaluations, in three virtual meetings of the GDG. Results: In seven sections covering the diagnostic and therapeutic management of perianal abscess and cryptoglandular anal fistula, there are 42 recommendations. Conclusion: This is an up‐to‐date international guideline on the management of cryptoglandular anal fistula using methodology prescribed by the AGREE enterprise. [ABSTRACT FROM AUTHOR]