OUTCOME AT 3 TO 5 YEARS OF PRIMARY CLOSURE OF PERIANAL AND PILONIDAL ABSCESS

Objective: To evaluate the long term results after primary closure of perianal abscess and pilonidal sinus. Design: Follow up by questionnai re and study of casenotes. Setting: University hospital and district h ospital. Subjects: 88 Patients who had previously been in a prospectiv e random control trial of two regimens of antibiotic treatment (ampici llin and metronidazole for one compared with four days) before incisio n, curettage, and primary closure of perianal abscess or pilonidal sin us. Main outcome measures: Recurrence rate and outcome. Results: 32 Pa tients had perianal abscesses of which 31 (97%) healed primarily (95% confidence interval [CI] 84 to 100%) with 4 recurrences (13%, 95% CI 2 to 24%). 56 Patients had pilonidal sinuses or abscesses of which 46 ( 82%) healed primarily (95% CI 70 to 91%) with 14 recurrences (30%, 95% CI 16 to 40%). There were no significant differences between the two antibiotic regimens. The mean followup was 53 months. Two patients had died, both had had perianal abscesses. Pilonidal sinuses tended to re cur during the first year, whereas pilonidal abscesses recurred after a lapse of two years or more. Half the patients who had had previous o perations for the same complications, compared with a third who were b eing operated on for the first time. Conclusions: A one day course of ampicillin and metronidazole is not associated with any more complicat ions than a four day course. Perianal abscesses respond well to primar y closure, but management of pilonidal abscesses and sinuses is more d ifficult.