Recurrence Rate Of Abscess Research Articles

A systematic review and meta-analysis of the use of packing in the management of perianal abscesses.

Perianal abscesses are common presentations and reasons for emergency general surgery admissions. Management involves incision and drainage of the abscess and packing the cavity with internal wound dressings. This meta-analysis aimed to assess in adults if packing an abscess or leaving it unpacked leads to a significant difference in the outcomes of pain on wound dressing, time to healing, rate of fistulation and abscess recurrence. Randomised controlled trials (RCTs) with participants aged 18 years or older that compared packing of perianal abscess cavities with no packing between 2002 and 2022 were searched for in December 2022 on OVID Medline and Embase, the CENTRAL register of trials, PubMed and Google Scholar. Risk of bias was assessed using the Cochrane Risk of Bias tool. Random effects meta-analysis was conducted on the data extracted. Three RCTs involving 490 patients were analysed for the outcomes of abscess recurrence and postoperative fistula formation; the data were not adequate to assess pain on dressing and time to healing. For unpacked versus packed, the pooled relative risk of abscess recurrence was 1.57 (95% confidence interval (CI) 0.764, 3.29, p=0.219) and for fistula formation 0.686 (95% CI 0.430, 1.09, p=0.114). These results suggest there is no significant benefit to packing abscess cavities. Analysis of the outcomes suggests there is no significant difference with regards to rates of abscess recurrence or fistula formation between the packed and unpacked groups; however, appropriately powered RCTs are required in this area to provide more primary evidence to inform best practice and clinical management.

Trocar puncture with modified sump drainage for duodenal stump fistula after radical gastrectomy for gastric cancer: A retrospective controlled study

Duodenal stump fistula (DSF) is a serious complication of radical gastrectomy for gastric cancer. Herein, we illustrated an innovative choice for treating duodenal stump fistulas by placing a modified sump drainage through trocar puncture into the DSF-related abscess (DSF-abscess) cavity. We retrospectively analyzed 974 consecutive patients who underwent gastrectomy for gastric cancer between 2011 and 2021. Of these patients, 34 who developed postoperative duodenal stump fistulas postoperatively were enrolled into our study, and their clinical data were retrospectively assessed. From January 2011 to December 2017, 15 patients received conventional treatments (percutaneous catheter drainage, PCD group) known as the traditional percutaneous method, and 19 patients from January 2018 to December 2021 received new treatments (Troca's SD group) consisting of conventional therapies and placement of a modified sump drainage through trocar puncture into DSF-abscess cavity. The demographics, clinical characteristics and treatment outcomes were compared between two groups. Compared with the PCD group, the rates of postoperative complications, duodenostomy creation, subsequent surgery, fistula healing rates of the DSF, and length of postoperative hospital stay were significantly decreased in the Troca SD group. However, there was no significant difference in the abscess recurrence rate and mortality rates. Trocar puncture with a modified sump drainage is an safe, effective, and technically feasible treatment for duodenal stump fistula after radical gastrectomy for gastric cancer. This novel technique should be further investigated using large-scale RCT research.

Trocar-assisted percutaneous abscess drainage: A better way to treat intra-abdominal abscess

Objective: This study aimed to introduce trocar-assisted percutaneous abscess drainage (TA-PAD) and compare it to the Seldinger puncture with pigtail drain (SPD) in the clinical treatment of intra-abdominal abscess. Materials and Methods: The clinical data of 23 patients with abdominal abscess treated with TA-PAD from 2017 to 2019 were retrospectively analyzed. Moreover, 18 patients with abdominal abscess treated with SPD from 2014 to 2016 were taken as the control. The therapeutic effects were compared between the two groups. Results: No death or surgery-related complications were observed in either group. There were significant differences between the two groups in the drainage rate of open surgery, the complete healing time of abscess, the time of inflammation relief, the recurrence rate of abscess, and the hospitalization cost (P < 0. 05). There was no significant difference in the duration of antibiotic use between the two groups (P > 0. 05). Conclusions: TA-PAD can optimize the treatment of abdominal abscesses with significantly lower surgical drainage rates, shorter hospital stays, lower recurrence rates, and lower hospital costs.

Drainage of anorectal abscesses in the operating room is associated with a decreased risk of abscess recurrence and fistula formation

BackgroundTimely incision and drainage (I&D) is first line management for anorectal abscesses. We aimed to define current practices in anorectal abscess management and identify factors associated with abscess recurrence and fistula formation. MethodsIndex episodes of anorectal abscesses treated with I&D in 2014–2018 at a multi-hospital healthcare system were included. Association with one-year abscess recurrence or fistula formation was evaluated using Cox proportional hazard regression. Fistulae were captured only among patients without fistulae at the index operation. ResultsA total of 458 patients met study criteria. One-year rate of abscess recurrence or fistula formation was 20.3%. When compared to bedside procedures, drainage in the operating room was associated with a reduced risk of either recurrence or fistula formation (aHR 0.20 [95%CI 0.114–0.367]). ConclusionsImproved exposure and patient comfort in the operating room may allow more complete drainage contributing to decreased rates of abscess recurrence or fistula formation.

Incision and Drainage With Primary Fistulotomy of Perianal Abscess Is Safe and Effective in Neonates: A Long-Term Follow-Up Study.

ObjectivePerianal abscess (PA) in neonates is poorly understood, and its management remains controversial. The aim of this study was to compare incision and drainage (ID) with or without primary fistulotomy in the management of neonatal first-time PA.MethodsA retrospective comparative study was conducted for neonates with first-time PA treated with incision and drainage with primary fistulotomy (IDF) vs. ID between 2008 and 2017.ResultsIn total, 138 patients (137 boys and 1 girl) were identified; 65 in the IDF group and 73 in the ID group. The median follow-up was 6.5 years (range 4–13 years). Baseline characteristics were similar between the 2 groups. The cure rate in the IDF group (98.5%, 64/65) was significantly higher than that in the ID group (80.8%, 59/73; p = 0.001). The rate of fistula formation in the IDF group (1.5%, 1/65) was significantly lower than that in the ID group (13.7%, 10/73; p = 0.01). The rate of abscess recurrence was not statistically different (p = 0.12), even though the IDF group (0%, 0/65) seemed to have a better outcome than the ID group (5.5%, 4/73). No fecal incontinence was observed in any of our patients.ConclusionsFirst-time PA in neonates can be treated safely and effectively by the IDF or by ID alone. The former may be advantageous over the latter in terms of the rate of cure and fistula formation.

Antibiotic Resistance Pattern in Pediatric Deep Neck Space Infection.

Introduction Neck space infection in the pediatric age group is common but can be life-threatening if not diagnosed properly. Since it is a polymicrobial disease, antibiotic usage should be guided by culture sensitivity pattern. Objectives To assess the microbiology, antibiotic resistance pattern and the outcome of the medical and surgical management of deep neck space infection in children. Methods This was a prospective study of children admitted for management of neck space infection from August 2017 to August 2018. The age, gender, organisms isolated, sensitivity and resistance to antibiotics, length of hospital stay, complications, and recurrence were noted. The descriptive data were analyzed. Results Out of 108 cases, there were 51 males (47.2%) and 57 females (52.8%) ranging from 1 month to 15 years, with a mean age of 5.32 +/- 4.35 years. The mean period of hospitalization was 6.98 days. Staphylococcus aureus was the most common organism isolated with less coagulase-negative staphylococci and streptococci. Clindamycin was the most sensitive drug (82.35%) followed by vancomycin and cloxcillin, while amoxicillin/ampicillin, a commonly used drug, was the least sensitive (20.58%). The abscess recurrence rate was 9.28%. The outcomes of either medical treatment or a combined medical or surgical treatment in properly selected cases were comparable. Conclusion Clindamycin or cloxacillin can be used as a first-line option for neck infection in children. Ampicillin/amoxicillin alone has a small role in neck abscess because of high resistance to this type of antibiotic.

Use of a punch biopsy tool as an alternative approach for incision and drainage of abscesses

The incision and drainage of an inflamed or infected cutaneous abscess is a common medical intervention. Traditionally, common practice involves the insertion of a #11 (or similar) scalpel blade to incise an abscess, forming a small linear opening superficially, thus allowing the drainage of purulent contents over several days. Premature skin closure occurs frequently due to the linear wound edges yielding to close approximation. In an effort to avoid this complication, providers often choose to pack the wound. However, randomized controlled trials and meta-analyses have shown no decrease in abscess recurrence rates with wound packing and further suggest postprocedural pain and costs are reduced without wound packing. 1 Mohamedahmed A.Y.Y. Zaman S. Stonelake S. et al. Incision and drainage of cutaneous abscess with or without cavity packing: a systematic review, meta-analysis, and trial sequential analysis of randomised controlled trials. Langenbecks Arch Surg. 2021; 406: 981-991 Crossref PubMed Scopus (4) Google Scholar ,2 Kessler D.O. Krantz A. Mojica M. Randomized trial comparing wound packing to no wound packing following incision and drainage of superficial skin abscesses in the pediatric emergency department. Pediatr Emerg Care. 2012; 28: 514-517 Crossref PubMed Scopus (35) Google Scholar

A systematic review and meta-analysis of incision and seton drainage in the treatment of high perianal abscess.

Surgery is the clinically preferred treatment for high perianal abscesses. Incision and seton drainage improve the cure rate and reduce recurrence. We aimed to systematically evaluate the clinical effect and safety of incision and seton drainage in the treatment of high perianal abscess. China Knowledge Network (CNKI), WanFang database, VIP database, PubMed, and Cochrane Library were searched and all relevant Chinese and English language documents until July 2021were retrieved. All records that described randomized clinical trials (RCTs) of incision and seton drainage for the treatment of high perianal abscess were eligible. Documents that met the inclusion criteria were evaluated for bias using the Cochrane Collaboration Risk Evaluation Standard, and Revman5.4 software was used to analyze the data. Fourteen RCTs were included. The results of nine studies showed that the clinical cure rate of the incision-seton group was higher than that of the incision-drainage group (P<0.05). Seven studies showed that the wound healing time of the incision-seton group was shorter than that of the incision-drainage group (P<0.05). Four studies showed that the visual analogue scale (VAS) score of the incision-seton group was lower than that of the incision-drainage group (P<0.05). Five studies showed that the Wexner score of the incision-seton group was lower than that of the incision-drainage group (P<0.05). Six studies showed that the formation rate of anal fistula in the incision-seton group was lower than that in the incision-drainage group (P<0.05). Six studies demonstrated that the recurrence rate of abscess in the incision-seton group was lower than that in the incision-drainage group (P<0.05). Seven studies showed that the incidence of adverse events in the incision-seton group was lower than that in the incision-drainage group (P<0.05). Five studies demonstrated that the length of stay in the incision-seton group was shorter than that of the incision-drainage group (P<0.05). The choice of surgical methods in clinical research has always been controversial. The incision-seton method can effectively and safely treat high perianal abscess. However, the results of this meta-analysis still leave some gaps in the evidence. More large-sample, high-quality, and multi-center RCTs are needed.

524 Anaesthetic Use and Packing in Subcutaneous Abscess Management: A Retrospective Before and After Analysis Within A Two-Cycle Audit

IntroductionIn the United Kingdom, there are no widely used guidelines within the management of subcutaneous abscesses by incision and drainage (I&D) to direct the use of local anaesthesia (LA) vs genal anaesthesia (GA); or the use of wound packing vs no packing.MethodTwo cohorts of patients undergoing I&D procedures were retrospectively identified from attendance records over a 3.5-month period. The first cohort was between 16th October 2018 to 31st January 2019. The second cohort of patients was during the COVID-19 pandemic following the introduction of new RCS guidance (intervention) between 29th March 2020 and 15th June 2020.ResultsSeventy-one patients before and 63 after the intervention were included. There were significantly more procedures performed under LA after the introduction of the intervention (n = 52; 82.5%) vs before (n = 4; 5.6%) p < 0.0001. The incidence of wound packing decreased after the intervention (n = 43; 68.3% vs n = 62; 87.3%) p = 0.00452.ConclusionsThe results demonstrate that during the pandemic, change in practice resulted in more subcutaneous abscesses being treated with LA. The majority of abscesses were packed in both cohorts although the incidence declined after the intervention. Future research should explore the patient satisfaction regarding pain management and the abscess recurrence rate.

Surgical Treatment of Bartholin's Gland Abscess: Is Word Catheter Superior to Marsupialization?

Bartholin's gland abscess may occur in up to 2% of the women. Surgical drainage using the Word catheter application or marsupialization is the treatment of choice in the management of Bartholin's gland abscess. We aimed to compare the abscess recurrence rates between these 2 surgical methods. A retrospective cohort database study. A university-affiliated, high-volume teaching hospital in southern Israel. All women who were surgically treated for Bartholin's gland abscess. Different clinical and postoperative characteristics were retrieved from the patients' records. A univariate analysis was conducted, and p <.05 was considered significant. During the study period, 321 women were admitted to our center with Bartholin's gland abscess and were managed surgically. Of these, 215 (67%) were treated using the Word catheter and 106 (33%) by drainage and marsupialization. No differences were found in clinical and microbiologic features between the study groups. In addition, recurrence rates as well as recurrent admissions did not differ significantly. Postoperative complications were similar between the groups. Our study reassures that both the Word catheter application and marsupialization are appropriate and safe when treating Bartholin's gland abscess.

Abscess Management: An Evidence-Based Review for Emergency Medicine Clinicians.

Abscesses are commonly evaluated and managed in the emergency department. Recent research has evaluated the use of ultrasonography, packing, incision and drainage (I&D), and antibiotics. There are evidence-based nuances to the management of specific types of abscesses, such as Bartholin, breast, dental, hidradenitis suppurativa, peritonsillar, and pilonidal abscesses. This review provides emergency medicine clinicians with a summary of the current literature regarding abscess management in the emergency department. Ultrasound is valuable in diagnosing abscesses that are not clinically evident and in guiding I&D procedures. Although I&D is traditionally followed by packing, this practice may be unnecessary for small abscesses. Antibiotics, needle aspiration, and loop drainage are suitable alternatives to I&D of abscesses with certain characteristics. Oral antibiotics can improve outcomes after I&D, although this improvement must be weighed against potential risks. Many strategies are useful in managing Bartholin abscesses, with the Word catheter proving consistently effective. Needle aspiration is the recommended first-line therapy for small breast abscesses. Dental abscesses are often diagnosed with clinical examination alone, but ultrasound may be a useful adjunct. Acute abscess formation caused by hidradenitis suppurativa should be managed surgically by excision when possible, because I&D has a high rate of abscess recurrence. Peritonsillar abscesses can be diagnosed with either intraoral or transcervical ultrasound if clinical examination is inconclusive. Needle aspiration and I&D are both suitable for the management of peritonsillar abscesses. Pilonidal abscesses have traditionally been managed with I&D, but needle aspiration with antibiotics may be a suitable alternative. This review evaluates the recent literature surrounding abscess management for emergency medicine clinicians.

Prostatic abscess: A systematic review of current diagnostic methods, treatment modalities and outcomes.

Prostatic abscesses (PAs) are an uncommon urologic presentation with widely varying approaches in their diagnoses and management. This study, therefore, aims to systematically review the literature of PAs to identify common clinical presentations, evaluate currently utilized diagnostic and treatment modalities, and assess their outcomes. A systematic review of the literature was performed using the MEDLINE and EMBASE databases, from January 1968 to June 2019. Outcome measures extracted from identified articles included age, the underlying disease, identified pathogens, diagnostic tool utilized, treatment used, and various subsequent clinical outcomes. The literature search yielded 683 articles, with a final twelve included in the review, representing a total of 210 patients. Transrectal ultrasonography (TRUS) was the most commonly used imaging tool used to identify PAs in all twelve studies. The PAs were treated with conservative antibiotic treatment in seven studies. Transurethral resection of the prostatic abscess (TURP) was utilized in eight studies with an average abscess size of 3.87 cm (3.0-4.0 cm) and with an average hospital stay of 10.22 days in those undergoing TURP. Transperineal aspiration was seen in five studies and offered a less invasive treatment modality. Finally, TRUS-guided needle aspiration was seen in seven studies with an average hospital stay of 23.25 days. This was the longest of any identified modalities with an additional high rate of abscess recurrence. Diagnosis and treatment practices of PAs remain widely varied in the literature due to a lack of clear guidelines. Based on the current evidence, we provide recommendations of treatment based on abscess size, patient age, and clinical condition. While smaller abscesses may be suited to antibiotic or TRUS-guided aspiration, transurethral approaches should be considered for larger and more complex abscesses. However, the current evidence remains poor with further research required to determine the optimum treatment modalities for patients.

P351 Spontaneous intra-abdominal abscesses in Crohn’s disease: The experience of a tertiary centre

Abstract Background Crohn’s Disease (CD) is a transmural inflammatory disease with the possibility of pan-gastrointestinal involvement that could lead in 10–30% of the cases to spontaneous intra-abdominal abscesses (SIAP). Their management is multidisciplinary and personalised. Our goal was to describe the acute management of SIAP in our centre, as well the recurrence rate of abscess and the need of elective surgery. Methods We retrospectively reviewed medical records of CD patients who have been admitted for intra-abdominal abscess between April 2009 and August 2017. Patients with secondary or perianal abscesses were excluded. Results 24 patients were included in this study with a mean time of hospital stay of 22.13 days. Seventy-nine per cent were male, the mean age was 39 years and 50% were smokers. According to Montreal’s Classification: 62,5% were A2, 58,5% L1 and 75% B3 (+p in 8,3%). 9 were under immunosuppressants (IS), 5 under corticosteroid and 4 under anti-TNF(2 combo therapy). All patients were admitted at the emergency room, more frequently with abdominal pain. 20,8% had SIAP as the first manifestation of CD. The most frequent location was inner loops(mean size was 5.54 cm (0.5–13 cm)). All the patients were prescribed with antibiotics; 10 had only antibiotic; 10 also performed percutaneous drainage(PD); 3 underwent surgical drainage, and 1 suffer from spontaneous drainage by an enterocutaneous fistula. Treatment failure was seen in 1 patient of antibiotic and PD groups. 83,3% underwent exclusive enteral nutrition during the hospital stay. 36,4% started corticotherapy. During follow-up, 33,3% added anti-TNF and 15 patients underwent elective surgery ±11.1 month after the discharge. Only 1 relapse of the SIAP was identified after 8 months of discharge. No deaths due CD were observed. Conclusion Our population consisted of predominately in young males, with younger age at the diagnose of CD, with ileal involvement and under IS. 5 patients had SIAD as the first manifestation of CD. The majority of the SIAP was controlled in acute context with only 1 patient showing a recurrence of SIAP. 15 patients needed elective surgery in the follow-up period, and 33,3% escalated medical therapy. Our results regarding the need for elective surgery aren’t far from published. More studies with larger cohorts are needed highlighting the individual management of each patient.

Traditional herbal enema combined with vacuum sealing drainage for perianal abscess

Objective To evaluate the efficacy of traditional herbal enema combined with vacuum sealing drainage in the treatment of perianal abscess. Methods A total of 87 patients who met the inclusion criteria were randomly divided into control group (43 cases) and study group (44 cases) by random number table method. The control group was treated with vacuum sealing drainage. The study group was given traditional herbal enema on the basis of the control group. Both groups were treated for 20 days and followed up for 6 months. The WBC, neutrophil count (NEU) and neutrophil percentage (NEU%) was measured by automatic blood cell analyzer, and the hospitalization and wound healing time was recorded. The recurrence rate of abscess and secondary anal fistula was observed during the follow-up period. Results The total effective rate was 97.7% (43/44) in the study group and 88.4% (38/43) in the control group. There was significant differences between the two groups (χ2=4.010, P=0.045). The hospitalization time (14.2 ± 0.6 d vs. 17.0 ± 1.2 d, t=13.970) and wound healing time (45.6 ± 0.7 d vs. 48.7 ± 1.2 d, t=15.216) in the study group was significantly shorter than those in the control group (P<0.01). After treatment, the WBC, NEU and NEU% level in the study group was significantly lower than those in the control group (t=23.318, 12.827, 46.630, all Ps<0.01). After 6 months of follow-up, the recurrence rate of abscess and the secondary anal fistula rate in the study group was significantly lower than those in the control group(χ2=12.813, 4.225, respectively, P<0.01 or P<0.05). Conclusions Traditional herbal enema combined with vacuum sealing drainage can significantly shorten the hospitalization and wound healing time, reduce the recurrence of abscess and secondary anal fistula, and improve the clinical efficacy. Key words: Anorectal disease; Negative-pressure wound therapy; Drainage; Enema therapy

The effect of stereotactic intracavity injection of antibiotics on systemic antibiotics therapy in patients with brain abscess

Objective To investigate the feasibility of intracavity administration of high-dose antibiotics to shorten the course of systemic antibiotic therapy. Methods A total of 107 patients with bacterial brain abscesses (155 abscesses) who were treated with stereotactic aspiration and intracavity injection of high-dose antibiotic combined with systemic antibiotic therapy(intracavitary treatment group) at Department of Neurosurgery, Chinese PLA General Hospital Sixth Medical Center from January 2005 to June 2018 were enrolled in this study. From January 1995 to December 2004, 51 patients with bacterial brain abscesses who were admitted to Department of Neurosurgery, Chinese PLA General Hospital Sixth Medical Center were treated with traditional stereotactic surgery (traditional treatment group). Clinical characteristics, treatment and prognosis in the 2 groups were compared. Results During the follow-up period (mean: 26.2±12.5 months, range: 6-72 months), all the abscesses of the intracavitary treatment group subsided with no recurrence. No adverse effects related to topical use of antibiotics occurred. At the end of follow-up, 78 patients had good outcomes, 21 had mild neurological deficits, 3 had moderate deficits, 1 was in vegetative state, and 4 died of accidents not related to brain abscesses. The course of systemic antibiotic application in the intracavitary treatment group was shorter than that in the traditional treatment group (21.5±2.3 d vs. 36.3±5.2 d, t=25.765, P 0.05). Conclusions Our preliminary results indicated that the local application of antibiotics in brain abscess cavity could reduce the length of time of systemic antibiotic therapy. This treatment could reduce the abscess recurrence rate compared to traditional treatment. Key words: Brain abscess; Stereotactic aspiration; Antibiotics; Route of medication

Comparison of clinical efficacy of the new type of irrigation and aspiration therapy and vacuum sealing drainage in the treatment of high perianal abscess

Objective To compare the clinical efficacy of the new type of irrigation and aspiration therapy and vacuum sealing drainage in the treatment of high perianal abscess. Methods 72 consecutive patients with high perianal abscess accepted to our department were randomized into the observation group and the control group, 36 cases in each group. The observation group underwent new type of irrigation and aspiration therapy and the control group underwent vacuum sealing drainage therapy. Preoperative, intraoperative and post-operative patient characteristics were evaluated. Results Compared with control group, the incision length of observation group was significantly shorter [ (15.2±3.6) mm vs. (33.2±8.4) mm, t=-11.818, P=0.000], the operation time was significantly shorter too [ (14.2±2.6) min vs. (16.8±3.2) min, t=3.784, P=0.000], and the postoperative pain score was significantly lower [ (3.5±1.1) vs. (5.3±1.6), t=5.562, P=0.000], the wound healing time was significantly shorter [ (14.3±3.2) d vs. (18.2±4.8) d, t=-4.056, P=0.000]. While in wound healing rate (69.44% vs. 66.67%, χ2=0.064, P=0.800), fistula formation rate (22.22% vs. 25.00%, χ2=0.077, P=0.781), and abscess recurrence rate (5.56% vs. 8.33%, χ2=0.215, P=0.643), there were no significant differences between the two groups. Conclusion The new type of irrigation and aspiration therapy can reduce the surgical trauma, shorten the operative time, reduce the postoperative pain and shorten the wound healing time. The new type of irrigation and aspiration therapy is an effective method for minimally invasive treatment of high perianal abscess. Key words: Irrigation and aspiration therapy; Vacuum sealing irrigation and aspiration device; High perianal abscess; Vacuum sealing drainage

Application of transitional care based on mobile APP in postoperative rehabilitation of patients with perianal abscess

Objective To explore the application effects of transitional care base on mobile APP for perianal abscess patients with postoperative rehabilitation. Methods A total of 97 perianal abscess patients, who were treated in the Department of Integrated Chinese and Western Medicine of West China Hospital of Sichuan University from February 2015 to February 2016, were divided into observation group (n=49) and control group (n=48) by the random number table. Patients in the control group were followed up by phone call, while patients in the observation group were given transitional care based on mobile APP with apricot trees-chart file. Wexner incontinence score, clinical recovery time and postoperative abscess recurrence rate, wound false-healing rate and the incidence of anal fistula were compared between the two groups after discharge. Results One month after discharge, the anus Wexner score of patients in observation group was (7.51±1.60) and the wound healing time was (20.71±2.48) d, which were all lower than that of the control group, and the differences were statistically significant (t=7.355, 15.291; P<0.01) . The recurrence rate of abscess in the observation group was 2.0%, the rate of wound pseudo-healing was 8.2%, the incidence of anal fistula was 16.3%, and the control group was 14.6%, 27.1% and 37.5%, the two groups had statistically significant differences (χ2= 5.603, 6.005, 5.541; P<0.05) . Conclusions Transitional care base on mobile APP can effectively reduce complications and improve anal function recovery in patients with perianal abscess patients. Key words: Anus diseases; Perianal abscess; Transitional care; Mobile application

CONSORT: May stereotactic intracavity administration of antibiotics shorten the course of systemic antibiotic therapy for brain abscesses?

Background:Despite advances in surgical techniques in the management of the brain abscess, continuous systemic long-term antibiotics are necessary and crucial. This study was designed to evaluate the effect of intracavity administration of high-dose antibiotics on the course of antibiotic therapy.Methods:Between 2003 and 2013, 55 patients with bacterial brain abscesses (83 abscesses) were treated with stereotactic aspiration and intracavity injection of high-dose antibiotics combined with a short course systemic antibiotic therapy. Antibiotics of one-eighth daily systemic dosage were injected into the abscess cavity after stereotactic aspiration and intravenous antibiotics were given in all patients for 3 to 4 weeks. The results of the group treated with stereotactic aspiration and intracavity injection of antibiotic solution were compared to the results of our previous patients treated by stereotactic aspiration only.Results:Thirty-nine males and 16 females (age ranging from 1.5 to 76 years; mean age 38.7 years) were included in this study. During the follow-up (mean 26.2 months, ranging from 6 to 72 months), all the abscesses subsided with no recurrence. No adverse effects related to topical use of antibiotics occurred. At the end of follow-up, 38 patients had good outcomes, 11 had mild neurological deficits, 3 had moderate deficits, 1 was in vegetative state, and 2 died of accidents not related to brain abscesses. Compared with conventional stereotactic aspiration and drainage, intracavity injection of antibiotics shorted the course of consecutive systemic intravenous antibiotics by average 10.8 days without an increase of the recurrence rate of abscesses.Conclusions:Our results indicate that topical application of antibiotics into the brain abscess cavity helps to reduce the length of systemic antibiotic therapy, decreases the abscess recurrence rate, avoids the side effects of long-term high dose antibiotics, shortens the hospitalization and reduces treatment costs.

A Randomized Controlled Trial Comparing Packing with Nonpacking of Perianal Abscess Cav

Introduction: Anorectal abscess is a potentially debilitating condition and one of the common anorectal conditions encountered in practice. Anorectal abscesses are defined by the anatomic space in which they develop and are more common in the perianal and ischiorectal spaces. Traditional management of perianal abscess involves early incision, drainage, curettage and packing of the residual cavity. Cavity packing and dressings are problematic in that they cause significant discomfort and require multiple visits to change the packing until healing. An alternative to the traditional approach is to perform adequate incision and drainage and then to allow healing without the use of cavity dressings.&#x0D; Objective: To compare the effects of packing with nonpacking of the perianal abscess cavity on patient discomfort and wound healing and subsidiary evaluation of the clinical outcomes.&#x0D; Materials and Methods: This single centre randomized controlled trial was carried out on 50 patients who were operated upon for perianal abscess in Combined Military Hospital, Dhaka during the period of July 2014 to June 2016. Patients were randomly assigned to receive either packing or nonpacking treatment through allocation by sealed envelope. The packing (control) group was instructed to report to a single nursing staff for subsequent dressing with packing of the residual cavity. The nonpacking group was discharged with a superficial protective dressing; they did not undergo wound dressing but managed their own wounds until follow-up. Outcome measures were time of healing, abscess recurrence, fistula formation and post operative pain.&#x0D; Results: A total of 54 patients were enrolled (4 lost in follow-up): 24 in the packing and 26 in the nonpacking arm. The two groups were comparable in terms of age and gender distribution, type, size of the abscess, duration of symptoms and length of follow-up. Healing in the non-packing group was faster compared to that of the packing group: mean 24.08 days versus 34.13 days (P=0.000). The rate of abscess recurrence was similar (P=0.664). Post operative fistula rates were similar (P=0.623). Pain scores appeared less in the nonpacking arm and statistically significant (7.25 vs. 4.24, P=0.000).&#x0D; Conclusion: Small size of the study population was the limitation of this study. In order to obtain a higher level of evidence, an adequately powered multicentre based prospective randomized controlled trial is required to definitely address the question of packing of the cavity and its beneficial outcome following incision and drainage in the management of perianal abscess.&#x0D; Journal of Armed Forces Medical College Bangladesh Vol.12(2) 2016: 111-116

A study assessing postoperative Corrugate Rubber drain of perianal abscess.

BackgroundPerianal abscess which can lead to a devastating complications. The management of perianal abscess involves incision and drainage by different methods one of them is packing the cavity.Aim of the studyThe aim is using Corrugate Rubber drain as an alternative to other methods.Patients and methodsThis study was an observational retrospective review of 137 'case series' of patients with perianal abscess over a fifteen-year period from January 2000 to December 2015. 67 patients in group A were managed by Corrugated Rubber drain and 70 patients in group B were managed by packing. In group A, males were 92.53% more than females (7.46%) while group B, males were 85.71% and the rest were females. Outcome measures were assessed; time to cavity healing, pain scoring, abscess recurrence, fistula formation, analgesic requirement and skin disfigurement.ResultsThe mean time of abscess healing in group A and B were 8.50 ± 0.49 and 8.90 ± 0.23 days respectively. Their pain score using Corrugate Rubber drain postoperative were 2/10 in group A while group B was 8/10. Most of patients in group A needed mild analgesia (52/67) (77.61%). The rate of abscess recurrence and fistula development were (22/67) (32.83%) and (21/67) (31.34%) respectively in group A which is significantly lower than group B.ConclusionsManagement of perianal abscess using Corrugate Rubber drain in compares with packing leads to immediate pain relief, low recurrence rate of abscess and fistula formation, without need to expert nursing and less ugly scar formation. This resulted in low morbidity and cost.