Experience on the treatment of anorectal abscesses with primary or ligation fistulotomy

Abstract

INTRODUCTION : Anorectal abscess (ARA) is frequently treated inappropriately with a simple incision and drainage. In 30-50% of the patients this leads to recurrent ARA, chronic rectal fistula and several hos­pital admissions. PATIENTS AND METHODS : For a ten years period, from 2007 till 2016, 547 patients with ARA were operated. Males were 419 and females 128, with a ratio of 3.3:1. Depending on localization, we divide four types of ARA: perianal - 281 patients (51.4%), ischiorectal - 176 patients (32.2%), intersphincteric - 56 pa­tients (10.2%), supralevator - 34 patients (6.2%). RESULTS : Radical operative treatment of ARA depends of type and location of abscess, its relationship to the sphincter and the extent of the inflammatory process. In 204 patients (37.3%) was performed incision, revision and drainage. In perianal, lower types of intersphincteric ARA incision, revision, excision of the fistula and the crypt is performed. This kind of operation we carried out on 181 patients (33.1%). In all is­chiorectal, high intersphincteric and supralevator ARA we made wide incision, digital revision, necrecto­my, drainage and seton ligation for gradual and continuous section of the sphincter, performed on 162 pa­tients (29.6%). CONCLUSIONS : Surgical tactics based on individual and differentiated approach of ARA treatment in specialized coloproctologic clinics assures effective and radical management, avoiding secondary abscess or chronic fistulization. Although still on debate, the primary or ligation fistulotomy should become a meth­od of choice for the radical treatment of ARA, eliminating the possibility of recurrent inflammation or fis­tula-in-ano. Scr Sci Med 2017; 49(3): 45-48