Incidence of fistula-in-ano after drainage of perianal abscess: a retrospective comparison of drainage alone versus drainage with primary fistula treatment
DOI:
https://doi.org/10.18203/2349-2902.isj20262459Keywords:
Fistula-in-ano, Fistulectomy, Fistulotomy, Incision and drainage, Perianal abscessAbstract
Background: Perianal abscess is a common anorectal surgical emergency, most often resulting from cryptoglandular infection. While incision and drainage (I&D) is the standard treatment, persistence of the underlying septic focus may lead to recurrent abscess or fistula-in-ano. The benefit of performing fistulotomy or fistulectomy at the time of abscess drainage remains debated because of concerns regarding sphincter injury and functional outcomes.
Methods: This retrospective comparative study included adult patients who underwent surgery for perianal or ischiorectal abscess between June 2018 and April 2023 at Sagar Hospital and Shanthi Hospital and Research Centre, Bengaluru. Patients were treated with either I&D alone (Group A) or I&D with concomitant fistulotomy/fistulectomy (Group B). Outcomes were assessed after a minimum follow-up of one year using a structured telephonic questionnaire and review of available clinical records.
Results: Of 136 patients treated during the study period, 15 were lost to follow-up. The final analysis included 121 patients: 49 in Group A and 72 in Group B. Abscess recurrence occurred in 20.4% of Group A patients compared with 4.2% in Group B (p=0.0065; RR 4.9, 95% CI 1.4–17.0). Fistula-in-ano developed in 6.1% and 2.7% of patients, respectively, with no statistically significant difference (p=0.394; RR 2.2, 95% CI 0.4–12.5).
Conclusions: Concomitant fistulotomy or fistulectomy at the time of abscess drainage was associated with significantly lower abscess recurrence. A selective approach to definitive fistula treatment during the index procedure may be beneficial in carefully selected patients with identifiable fistulous pathology.
References
Parks AG. Pathogenesis and treatment of fistula-in-ano. Br Med J. 1961;1:463–9.
Oliver I, Lacueva FJ, Pérez Vicente F, Arroyo A, Ferrer R, Calpena R. Randomized clinical trial comparing incision and drainage alone versus incision and drainage with fistulotomy for perianal abscess. Int J Colorectal Dis. 2003;18:107–10.
Hasan Z, Khan MA, Abbas Z. Frequency of fistula-in-ano following incision and drainage of perianal abscess. Ann Coloproctol. 2016;32:150–3.
Breen M, El-Gazzaz G, Farag A. Outcome of primary fistulotomy during drainage of perianal abscess. Med J Cairo Univ. 2015;83:327–32.
Schouten WR, van Vroonhoven TJ. Treatment of anorectal abscess with or without primary fistulectomy: results of a prospective randomized trial. Dis Colon Rectum. 1991;34(1):60–3.
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):6827.
Tang CL, Chew SP, Seow-Choen F. Prospective randomized trial of drainage alone versus drainage and fistulotomy for acute perianal abscesses with proven internal opening. Dis Colon Rectum. 1996;39(12):1415–7.
Ho YH, Tan M, Chui CH, Leong A, Eu KW, Nyam D. Randomized controlled trial of primary fistulotomy with drainage alone for perianal abscesses. Dis Colon Rectum. 1997;40(12):1435–8.
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