Hidradenitis suppurativa (HS) is a chronic relapsing inflammatory disease that primarily affects the apocrine skin glands. Management options include risk factor modification, pharmacologic agents, and surgery. Many surgical management techniques exist, including incision and drainage, laser hair removal, deroofing, limited or wide local excision. Deroofing is an interesting alternative for simple superficial fistulas and potentially even for more complex lesions. Surgical treatment can be combined with drug treatment. The indication depends on a comprehensive and multidisciplinary assessment considering the severity and number of target lesions.