RANDOMIZED CONTROLLED TRIAL OF PRIMARY FISTULOTOMY WITH DRAINAGE ALONE FOR PERIANAL ABSCESSES

PURPOSE: Primary fistulotomy may be advantageous for perianal abscesse s because unlike ischiorectal abscesses, fistulas are more commonly fo und and can be laid open with full preservation of the external anal s phincters. There fore, a randomized, controlled trial was conducted to compare primary fistulotomy with incision and drainage alone, specifi cally for perianal abscesses. METHODS: Fifty-two consecutive patients (43 males; mean age, 40 (standard error of mean, 2) years) with perian al abscesses were randomized to treatment by either incision and drain age (controls; N = 28) or fistulotomy (N = 24). Patients were followed up clinically for a mean of 15.5 (standard error of the mean, 0.7) mo nths. Anorectal manometry was also per formed before, six reeks, and t hree months after surgery. RESULTS: Persistent fistulas developing aft er surgery were significantly more common after incision and drainage (N = 7; 25 percent) than after fistulotomy (N = 0; P = 0.009). One pat ient in each group was also found to have a residual abscess, which re quired repeat drainage. Ail patients remained fully continent. The ana l pressures after incision and drainage and fistulotomy were not signi ficantly different. Operative time, hospital stay, and time for the wo und to heal completely were the same in both groups. CONCLUSIONS: Prim ary fistulotomy at the time of drainage for perianal abscesses results in fewer persistent fistulas and no added risk of fecal incontinence.