Perianal Abscess; Simple Drainage versus Drainage and Fistulotomy
Journal of Surgery
Volume 4, Issue 3-1, June 2016, Pages: 10-13
Received: Jan. 28, 2016; Accepted: Jan. 29, 2016; Published: Mar. 23, 2016
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Aly Saber, Department of General Surgery, Port-Fouad General Hospital, Port-Fouad, Egypt
Emad K. Bayumi, General Surgery, Medical Academy Named After S. I. Georgiesky of Crimea Federal University, Crimea, Russia
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Introduction: Perianal abscess is one of the most common general surgical emergencies encountered in clinical practice and the initial treatment is simple incision and drainage, other surgical procedures as fistulotomy may be required as a definitive measure for treating fistula because about 40% of patients present with a fistula after simple incision and drainage of their perianal abscesses. The aim of this study was to detect the outcome of simple drainage versus drainage and fistulotomy for perianal abscess as regard to abscess recurrence, fistula formation and time off from work. Patients and Methods: A total number of 200 patients of both sexes; 100 for each group, their ages ranged between 21- 65 years were enrolled to this parallel prospective randomized clinical trial where patients were divided randomly into two main groups; A and B. Group A patients [N =100] were subjected to simple incision & drainage and those of group B [N = 100] were subjected to drainage & fistulectomy for acute perianal abscess. End Points: The primary end points were abscess recurrence, fistula formation and incontinence. The secondary end points were time off from work, wound discharge, wound healing and patients’ satisfaction. Results: Patient’s satisfaction of the treatment maneuver in relation to abscess recurrence and fistula occurrence was 80 % and 95% of group A and B respectively. Conclusion: The present study showed that treatment of perianal abscess through the combined maneuver of incision – drainage with fistulotomy at the same time significantly reduced the likelihood of persistent abscess, recurrence and need for repeat surgery. Patient’s satisfaction after treatment with this combined method showed a significant value than incision – drainage only as regard disease recurrence, time of wound discharge and the incidence of fistula formation.
Perianal Abscess, Simple Drainage, Fistulotomy
To cite this article
Aly Saber, Emad K. Bayumi, Perianal Abscess; Simple Drainage versus Drainage and Fistulotomy, Journal of Surgery. Special Issue: Surgical Infections and Sepsis. Vol. 4, No. 3-1, 2016, pp. 10-13. doi: 10.11648/j.js.s.2016040301.12
Copyright © 2016 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Malik A, Hall D, Devaney R, Sylvester H, Yalamarthi S. The impact of specialist experience in the surgical management of perianal abscesses. Int J Surg. 2011; 9(6): 475-7.
Sneider EB, Maykel JA. Anal abscess and fistula. Gastroenterol Clin North Am. 2013; 42(4): 773-84.
Hamadani A, Haigh PI, Liu IL, Abbas MA. Who is at risk for developing chronic anal fistula or recurrent anal sepsis after initial perianal abscess? Dis Colon Rectum, 2009 (52): 217–221.
Ommer A, Herold A, Berg E, Fürst A, Sailer M, Schiedeck T. German S3 guideline: anal abscess. Int J Colorectal Dis. 2012; 27: 831–837.
Lohsiriwat V, Yodying H, Lohsiriwat D. Incidence and factors influencing the development of fistula-in-ano after incision and drainage of perianal abscesses. J Med Assoc Thai 2011; 93: 61–65.
Sözener U, Gedik E, Kessaf Aslar A, Ergun H, Halil Elhan A, Memikoğlu O, Bulent Erkek A, Ayhan Kuzu M.. Does adjuvant antibiotic treatment after drainage of anorectal abscess prevent development of anal fistulas? A randomized, placebo-controlled, double-blind, multicenter study. Dis Colon Rectum. 2011; 54: 923–929.
Imhoff LR, Brown JS, Creasman JM, Subak LL, Van den Eeden SK, Thom DH, Varma MG, Huang AJ. Fecal incontinence decreases sexual quality of life, but does not prevent sexual activity in women. Dis Colon Rectum. 2012; 55(10): 1059-65.
Saber A, Ellabban GM, Gad MA and Elsayem K. Open preperitoneal versus anterior approach for recurrent inguinal hernia: a randomized study. BMC Surgery 2012, 12:22 doi: 10.1186/1471-2482-12-22.
Jain BK, Vaibhaw K, Garg PK, Gupta S and Mohanty D. Comparison of a Fistulectomy and a Fistulotomy with Marsupialization in the Management of a Simple Anal Fistula: A Randomized, Controlled Pilot Trial. J Korean Soc Coloproctol. 2012; 28(2): 78–82.
Czeiger D, Shaked G, Igov I, Pinsk I, Peiser J, Sebbag G. High occurrence of perianal abscess among Bedouin compared to Jews in the southern region of Israel. BMC Surg. 2013; 12; 13: 35. doi: 10.1186/1471-2482-13-35.
De Oliveira PG; de Sousa JB; de Almeida RM; Wurmbauer IFS; dos Santos CAN and Filho JG. Anal fistula: results of surgical treatment in a consecutive series of patients. J. Coloproctol. (Rio J.), 2012; 32 (1): 60-64.
Abcarian H. Anorectal infection: abscess-fistula. Clin Colon Rectal Surg. 2011, 24 (1): 14–21.
Ulug M, Gedik E, Girgin S, Celen MK, Ayaz C. The evaluation of bacteriology in perianal abscesses of 81 adult patients. Braz J Infect Dis. 2010; 14(3): 225-9.
Wei PL, Keller JJ, Kuo LJ, Lin HC. Increased risk of diabetes following perianal abscess: a population-based follow-up study. Int J Colorectal Dis. 2013; 28(2): 235-40.
Rizzo JA, Naig AL, Johnson EK. Anorectal abscess and fistula-in-ano: evidence-based management. Surg Clin North Am. 2010; 90(1): 45-68.
Oliver, F. J. Lacueva, F. P. Vicente, et al. Randomized clinical trial comparing simple drainage of anorectal abscess with and without fistula track treatment. Int J Colorectal Dis, 2003, 18; 107–110.
Whiteford MH. Perianal Abscess/Fistula Disease. Clin Colon Rectal Surg. May 2007; 20(2): 102–109.
Lohsiriwat V, Yodying H, Lohsiriwat D. Incidence and factors influencing the development of fistula-in-ano after incision and drainage of perianal abscesses. J Med Assoc Thai. 2010; 93(1): 61-5.
Malik AI, Nelson RL, Tou S. Incision and drainage of perianal abscess with or without treatment of anal fistula. Cochrane Database Syst Rev. 2010, 7; (7): CD006827. doi: 10.1002/14651858.CD006827.
Ege B, Leventoğlu S, Menteş BB, Yılmaz U and Öner AY. Hybrid seton for the treatment of high anal fistulas: results of 128 consecutive patients. Tech Coloproctol. 2014; 18(2): 187–193.
Bokhari S, Lindsey I. Incontinence following sphincter division for treatment of anal fistula. Colorectal Dis. 2010; 12: 35–39.
Sharma D, Pipariya PR, Gupta S, Gupta A and Chopra N. Fistulectomy or Fistulotomy: Better Approach in Fistula-In-Ano. Sch. J. App. Med. Sci., 2014; 2(1B): 202-204.
Quah HM, Tang CL, Eu KW, et al. Meta-analysis of randomized clinical trials comparing drainage alone vs primary sphincter-cutting procedures for anorectal abscess-fistula. Int J Colorectal Dis 2006; 21(6): 602–9.
Inceoglu R and Gencosmanoglu R. Fistulotomy and drainage of deep postanal space abscess in the treatment of posterior horseshoe fistula. BMC Surgery 2003, 3:10 doi: 10.1186/1471-2482-3-10.
Saber A. Patients Satisfaction and Outcome of Fistulotomy versus Fistulectomy for Low Anal Fistula. Journal of Surgery. Special Issue: Gastrointestinal Surgery: Recent Trends. 2016, 4(2-1): 15-19.
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