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RESULTS OF A POLICY OF SELECTIVE IMMEDIATE FISTULOTOMY FOR PRIMARY ANAL ABSCESS
Author(s) -
SeowChoen F.,
Leong A. F. P. K.,
Goh H. S.
Publication year - 1993
Publication title -
australian and new zealand journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.111
H-Index - 51
eISSN - 1445-2197
pISSN - 0004-8682
DOI - 10.1111/j.1445-2197.1993.tb00433.x
Subject(s) - fistulotomy , medicine , abscess , sepsis , surgery , group b , incision and drainage , prospective cohort study , anal fistula , fistula
A prospective study of a policy of selective immediate fistulotomy in the management of acute primary anal abscesses was performed. Eighty‐nine patients (74%) underwent simple drainage only, as no internal openings were found during drainage of pus (group A). Thirty‐one patients (26%) had drainage of pus and immediate fistulotomy (group B). Follow up for groups A and B occurred at a median of 122 weeks (104–136 weeks) and 121 weeks (104–136 weeks), respectively. No patient in group A had residual problems with anal continence whilst two patients (6.5%) from group B had minor anal incontinence following the initial procedure ( p = 0.07). Ten patients from group A (11%) and four patients from group B (13%) developed recurrent anal sepsis. The overall rate of recurrent sepsis was 11.7%. In those patients who had incision and drainage alone, 90% of those who developed a recurrence and 71% of those who did not develop a recurrence grew gut‐associated organisms from pus obtained during the initial drainage of the acute abscess, giving a positive predictive value for recurrence of 13.8% for a culture of gut‐associated organisms. The positive predictive value for recurrent sepsis for both groups taken together for a culture of gut‐associated organisms was 28.2%. Patients with acute primary anal abscess should be treated with simple drainage.