Prospective Randomized Trial of Simple Drainage vs. Drainage and Initial Fistula Management for Perianal Abscesses

Background and Aims: Perianal abscess is one of the most frequent proctological disorders and needs urgent treatment. Incision and drainage consists the gold standard therapy of this disorder. However, due to high rates of abscess recurrence, few surgeons favor primary fistula treatment at the time of abscess drainage to decrease the risk of recurrence. This clinical study was designed to compare incision and drainage of perianal abscess with or without fistula treatment. Patients and Methods: Two hundred consecutive patients suffering from acute perianal abscess were prospectively randomized into two groups: group A; treatment of abscess with incision and drainage, group B; incision and drainage plus primary fistula treatment. All patients were followed-up for at least 12 months. Primary endpoints of the study were the rates of abscess recurrence and anal incontinence. Secondary end point was abscess recurrence rate during the overall follow-up period. Results: The 12-month recurrence rate was higher in group A than group B and this difference was statistically significant (44% in group A vs. 6% in group B, p<0.001). Four patients of group B suffered from postoperative incontinence (two with flatus and two with liquid incontinence), while no patient of group A experienced anal incontinence. However the difference between the two groups was not statistically significant (p=0.121). With a median follow-up of 31 months, the overall recurrence rate almost reached 70% in group A, while in group B it was only 10% (p<0.001). Conclusion: The results of our study show that management of perianal abscesses with drainage and synchronous fistula treatment can be effectively and safely performed by experienced surgeons, giving excellent results as far as recurrence and incontinence rates are concerned.