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

Treatment of an anal fistula at the same time as drainage of perianal abscess appears to reduce the chances of recurrent abscess and repeat surgery.

A Cochrane review included 6 studies with a total of 479 subjects comparing incision and drainage of perianal abscess alone versus incision and drainage with fistula treatment. There was a significant reduction in recurrence, persistent abscess/fistula or repeat surgery in favour of fistula surgery at the time of abscess incision and drainage (RR 0.13, 95% CI 0.07 to 0.24; 6 studies, n=474). Transient manometric reduction in anal sphincter pressures, without clinical incontinence, may occur after treatment of low fistulae with abscess drainage. Incontinence at one year following drainage with fistula surgery was not statistically significant (RR 3.06, 95% CI 0.7 to 13.45; 5 studies, n=401) with some heterogeneity between the trials (I² =44.4%).

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment).

Ədəbiyyat

1. 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):CD006827.