The incidence of recurrent abscesses or fistula-in-ano following anorectal suppuration

Abstract

To determine whether primary fistulotomy should be performed at the time of incision and drainage of anorectal abscesses, a retrospective study of 117 patients who underwent incision and drainage of anorectal abscesses was conducted to ascertain what percentage of patients would subsequently develop a fistula-in-ano or recurrent abscess. None of the patients treated for intersphincteric abscesses developed recurrences. Of the 83 patients with perianal or ischiorectal abscesses, 9 (11%) developed recurrent abscesses and 31 (37%) developed persistent fistula-in-ano for a combined persistence or recurrence rate of 48%. These data support the policy of secondary fistulotomy to avoid division of sphincter muscle in the 52% of patients who would not need it. In addition, the vast majority of perianal and ischiorectal abscesses can be drained under local anesthesia and hence a general anesthetic and hospital admission are obviated.