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

Dimitar Hadzhiev, Dzhevdet Chakarov, Evgenii Moshekov, Boris Sakakushev, Chavdar Atanasov, Elena Hadzhieva, Ivan Ivanov, Kostadin Kandilarov, Bozhidar Hadzhiev


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


anal abscess, anorectal abscess, fistula-in-ano, fistulotomy

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Oliver I, Lacueva FJ, Pérez Vicente F, Arroyo A, Ferrer R, Cansado P, et al. Randomized clinical trial comparing simple drainage of anorectal abscess with and without fistula track treatment. Int J Colorectal Dis. 2003;18(2):107-10.

Ho YH, Tan M, Chui CH, Leong A, Eu KW, Seow- Choen F. Randomized controlled trial of primary fistulotomy with drainage alone for perianal abscesses. Dis Colon Rectum. 1997;40(12):1435-8.

Seow-Choen F, Leong AF, Goh HS. Results of a policy of selective immediate fistulotomy for primary anal abscess. Aust N Z J Surg. 1993;63(6):485-9.

Cox SW, Senagore AJ, Luchtefeld MA, Mazier WP. Outcome after incision and drainage with fistulotomy for ischiorectal abscess. Am Surg. 1997;63(8):686-9.

Hämäläinen KP, Sainio AP. Incidence of fistulas after drainage of acute anorectal abscess. Dis Colon Rectum. 1998;41(11):1357-62.

Pigot F. Treatment of anal fistula and abscess. J Visc Surg. 2015;152(2 Suppl):S23-9. doi: 10.1016/j. jviscsurg.

Knoefel WT, Hosch SB, Hoyer B, Izbicki JR. The initial approach to anorectal abscesses: fistulotomy is safe and reduces the chance of recurrences. Dig Surg. 2000;17(3):274-8.

Wu CL. Experience on the treatment of acute anorectal abscess with primary fistulotomy. Gaoxiong Yi Xue Ke Xue Za Zhi. 1990;6(5):218-23 (in Chinese).

Malik A, Hall D, Devaney R, Sylvester H, Yalamarthi S. The impact of specialist experience in the surgical management of perianal abscesses. Int J Surg. 2011;9(6):475-7. doi: 10.1016/j.ijsu.2011.06.002.

1Holzheimer RG, Siebeck M. Treatment procedures for anal fistulous cryptoglandular abscess - how to get the best results. Eur J Med Res. 2006;11(12):501-15.

1Tang CL, Chew SP, Seow-Choen F. Prospective randomized trial of drainage alone vs. drainage and fistulotomy for acute perianal abscesses with proven internal opening. Dis Colon Rectum. 1996;39(12):1415-7.

1Benjelloun EB, Jarrar A, El Rhazi K, Souiki T, Ousadden A, Ait Taleb K. Acute abscess with fistula: long-term results justify drainage and fistulotomy. Updates Surg. 2013;65(3):207-11. doi: 10.1007/ s13304-013-0218-z.

Schouten WR, van Vroonhoven TJ. Treatment of anorectal abscess with or without primary fistulectomy. Dis Colon Rectum. 1991;34(1):60-3.

Athanasiadis S., Fischbach N, Heumüller L, Marla B. Abscess excision and primary fistulectomy as initial therapy of peri-proctal abscess. Chirurg. 1990;61(1):53-8 (in German).

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About The Authors

Dimitar Hadzhiev

Dzhevdet Chakarov

Evgenii Moshekov

Boris Sakakushev

Chavdar Atanasov

Elena Hadzhieva

Ivan Ivanov

Kostadin Kandilarov

Bozhidar Hadzhiev

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