ABSTRACT
Introduction
Management of perianal abscesses has remained largely unchanged for over 50 years. The evidence for postoperative wound packing is limited and may expose patients to painful procedures with no clinical benefit and at considerable increased cost.
MethodsPatients were recruited in 15 UK centers between December 2013 and October 2014. Outcome measures included number of dressing (pack) changes, healing, recurrence, return to work/normal function, postoperative fistula-in-ano and health utility scores (EQ-5D™). Pain was measured before, during, and after dressing change on a visual analog scale.
ResultsSome 141 patients were recruited (median age 39 [range 18–86] years). The mean number of dressing changes in the first 3 weeks was 13 (range 0–21), equating to an annual cost to the National Health Service of €6,453,360 in England alone per annum. Some 43.8% of wounds were healed by 8 weeks after surgery and 86% of patients had returned to normal function. Some 7.6% of abscesses had recurred and 26.7% of patients developed a fistula-in-ano by 6 months following surgery. Patients reported a two- to threefold increase in pain scores during and after dressing changes.
ConclusionsRecurrent abscess is rare, and fistula occurs in one-quarter of the patients. Packing is painful and costly.
