Incision and drainage of perianal abscess with or without treatment of anal fistula

Abstract

The published evidence shows fistula surgery with abscess drainage significantly reduces recurrence or persistence of abscess/fistula, or the need for repeat surgery. There was no statistically significant evidence of incontinence following fistula surgery with abscess drainage. This intervention may be recommended in carefully selected patients.

A retrospective analysis of 93 cases with anorectal abscess in a rural state hospital

“…Quah et al (6) performed a meta-analysis including 405 patients from five clinical studies, which could not demonstrate the superiority of fistula surgery without sphincter salvage over incision and drainage, and stated that randomized studies were required. However, a series published in 2010 including 479 patients showed that fistula surgery applied simultaneously with abscess drainage reduced the recurrence rate (5). Also, in our study, 10 patients identified to have fistula during drainage received simultaneous fistulotomy and no recurrences could be identified in their one-year follow-up.…”

“…The reason for this could be that the patients, who had the above-mentioned characteristics that would cause anorectal abscess development, were not included in the study, the number of patients was limited and the patients who developed recurrence preferred specialized centers. In a current meta-analysis, it was reported that the shortest follow-up period was 12 months and the longest follow-up period was 42.5 months for the included studies (5). The median follow-up period in our study was identified to be 9 months; the recurrence rate might have been found to be low on account of this short followup period.…”

“…The classical signs of acute anorectal abscesses include pain, swelling and occasionally fever; they are treated by adequate incision and drainage (1,2). Among anorectal abscesses, 90% develop as a result of non-specific cryptoglandular infection and nearly one third of anorectal abscesses are accompanied by anal fistula, which increases the abscess recurrence, repeated need for drainage and may result in life-threatening conditions such as perianal sepsis (3)(4)(5). This situation is worrisome for both the patient and the surgeon, and the repeated intervention requirements may prolong hospital stay and increase the cost.…”

Perianal abscess

“…25 In spite of evidence suggesting that treating an associated fistula in the acute setting reduces subsequent recurrence, 26 there is insufficient consensus to support surgeons undertaking immediate fistula treatment at incision and drainage of perianal abscesses, particularly if they are less experienced.…”

Controversies in Fistula in Ano

“…There has been much controversy whether all abscesses should be treated like fistula to lower recurrence rate. In a Cochrane database published in 2010 [3], six trials were identified, involving 479 subjects, comparing incision and drainage of perianal abscess alone versus incision and drainage with fistula treatment. The authors concluded that fistula surgery with abscess drainage significantly reduces recurrence or persistence of abscess/fistula, or the need for repeat surgery.…”