Background Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with increasing incidence. Severe disease stages are seen as a therapeutic challenge and pose the threat of significant restrictions on patients' life quality. Objectives We evaluated postoperative outcome after wide local excision for HS as well as postoperative course, cosmetic results, disease recurrence and quality of life. Methods All patients receiving radical surgical treatment for HS (Hurley III) between 2006 and 2015 were identified and received a letter‐based survey. They were asked about postoperative course, cosmetic results, recurrence and life quality. Results Two hundred and fifty‐five patients (103 men, 152 women) answered the questionnaire. Ninety‐five percentage of patients reported disease‐specific restrictions on everyday life. Seventy‐five percentage of patients did not experience any postoperative adverse events; however, postoperative pain with need for analgesics was reported in 38%. The majority of patients (80%) were very satisfied or satisfied after surgery, and 85% of patients would recommend surgery to other affected persons. Limitations The retrospective design of the study was a limitation. Conclusions The well‐known negative psychological and social effects are a relevant part of HS and emphasize the importance of immediate therapy. As long‐lasting local disease‐control can be achieved, surgery should be considered as first‐line therapy.