Risk factors for perianal abscess recurrence after incision and drainage: a review of the literature

Kheira Gabsi

doi:10.18203/2349-2902.isj20250159

Authors

Kheira Gabsi Department of Surgery, Campbelltown Hospital, Campbelltown, NSW, Australia

DOI:

https://doi.org/10.18203/2349-2902.isj20250159

Keywords:

Perianal abscess, Recurrence, Fistula, Risk factors

Abstract

Perianal abscesses are a commonly managed condition by general surgery, usually with antibiotics and an incision and drainage in the operating theatre. They are estimated to recur 30% of the time. This literature review was performed is to investigate risk factors for recurrence for perianal abscess. The 19 pertinent studies were included, which revealed that inflammatory bowel disease and abscess location have been repeatedly shown to be risk factors for recurrence of perianal abscess. There were numerous other risk factors including diabetes, smoking, patient age and gender, and pre-operative fever that were discussed in the literature but were not consistently between studies shown to be significant.

Metrics

Metrics Loading ...

References

Sahnan K, Adegbola SO, Tozer PJ, Josef W, Robin KP. Perianal abscess. BMJ. 2017;21:j356. DOI: https://doi.org/10.1136/bmj.j475

Sarofim M, Ooi K. Reviewing perianal abscess management and recurrence: lessons from a trainee perspective. ANZ J Surg. 2022;92(7-8):1781-3. DOI: https://doi.org/10.1111/ans.17750

Onaca N, Hirshberg A, Adar R. Early reoperation for perirectal abscess: a preventable complication. Dis Colon Rectum. 2001;356:1469-73. DOI: https://doi.org/10.1007/BF02234599

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. DOI: https://doi.org/10.1016/j.ijsu.2011.06.002

Lohsiriwat V, Yodying H, Lohsiriwat D. Incidence and factors influencing the development of fistula-in-ano after incision and drainage of perianal abscesses. Med J Med Assoc Thailand. 2010;93(1):61.

Hasan ZA, Mohamed B, AlSayegh R, AlMarzooq R. Incidence of anal fistula after pyogenic perianal abscess drainage in Kingdom of Bahrain. Ann Coloproctol. 2023;39(1):27. DOI: https://doi.org/10.3393/ac.2020.00962.0137

Sahnan K, Askari A, Adegbola SO, Tozer PJ, Phillips RK, Hart A, et al. Natural history of anorectal sepsis. J Brit Surg. 2017;104(13):1857-65. DOI: https://doi.org/10.1002/bjs.10614

Skovgaards DM, Perregaard H, Dibbern CB, Nordholm-Carstensen A. Fistula development after anal abscess drainage-a multicentre retrospective cohort study. Int J Colorectal Dis. 2023;39(1):4. DOI: https://doi.org/10.1007/s00384-023-04576-6

Barkai O, Abramov R, Harbi A, Gilshtein H. Characterization of risk factors affecting the recurrence of perianal abscesses and complications. Israel Med Assoc J. 2024;26(7):428-33.

Gokce FS, Gokce AH. Can the risk of anal fistula development after perianal abscess drainage be reduced? Rev Assoc Méd Brasileira. 2020;66:1082-6. DOI: https://doi.org/10.1590/1806-9282.66.8.1082

Dong S, Chen B, Zhang J. Study on the factors influencing the prognosis after perianal abscess surgery. BMC Gastroenterol. 2023;23(1):334. DOI: https://doi.org/10.1186/s12876-023-02959-1

Sözener U, Gedik E, Aslar AK, Ergun H, Elhan AH, Memikoglu O, et al. 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(8):923-9. DOI: https://doi.org/10.1097/DCR.0b013e31821cc1f9

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(2):217-21. DOI: https://doi.org/10.1007/DCR.0b013e31819a5c52

Nasasra A, Hershkovitz Y, Ashkenazi I, Hammerschlag J, Zmora O, Jeroukhimov I. Antibiotic Treatment Has No Influence on Anal Fistula Formation and Recurrent Perianal Abscess After Incision and Drainage of Cryptogenic Perianal Abscess: A Randomized Single-Blind Prospective Study. Dis Colon Rectum. 2024;67(8):1072-6. DOI: https://doi.org/10.1097/DCR.0000000000003334

Crook DL, Padfield OM. A systematic review and meta-analysis of the use of packing in the management of perianal abscesses. Ann R Coll Surg Engl. 2024;107(1):29-34. DOI: https://doi.org/10.1308/rcsann.2023.0108

Tonkin DM, Murphy E, Brooke-Smith M, Hollington P, Rieger N, Hockley S, Richardson N, Wattchow DA. Perianal abscess: a pilot study comparing packing with nonpacking of the abscess cavity. Dis Colon Rectum. 2004;47(9):1510-4. DOI: https://doi.org/10.1007/s10350-004-0620-1

Newton K, Dumville J, Briggs M, Law J, Martin J, Pearce L, et al. Postoperative packing of perianal abscess cavities (PPAC2): randomized clinical trial. Brit J Surg. 2022;109(10):951-7. DOI: https://doi.org/10.1093/bjs/znac225

Khalil OM, Al Ozaibi L, Kaiyasah HM, Hejazi NA. Incidence and risk factors affecting development of perianal fistulas after drainage of perianal abscesses. Dubai Med J. 2021;4(1):43-6. DOI: https://doi.org/10.1159/000513277

Turner GA, Tham N, Chandra R, Read DJ, Chittleborough TJ, McCormick JJ, et al. Management of acute perianal abscess: is surgeon specialization associated with improved outcomes? ANZ J Surg. 2024;94(5):938-44. DOI: https://doi.org/10.1111/ans.18836

Malik AI, Nelson RL, Tou S. Incision and drainage of perianal abscess with or without treatment of anal fistula. Coch Datab Systemat Rev. 2010;7:CD006827. DOI: https://doi.org/10.1002/14651858.CD006827.pub2