The management of hidradenitis suppurativa is frequently unsatisfactory. No method satisfies all requirements for the ideal treatment--quick healing, no hospital admission, minimal patient inconvenience and low recurrence--but greater awareness of the strengths and weaknesses of existing methods should lead to improved management. Good reports of the relative cure rates of the different surgical options are scarce and controlled trials non-existent, but existing evidence is reviewed critically and summarized. The operation of choice in most instances is wide local excision and healing by secondary intention.