Kpj. Hamalainen et Ap. Sainio, INCIDENCE OF FISTULAS AFTER DRAINAGE OF ACUTE ANORECTAL ABSCESSES, Diseases of the colon & rectum, 41(11), 1998, pp. 1357-1361
PURPOSE: The aim of this study was to assess the incidence of anal fis
tulas and factors related to this incidence after incision and drainag
e of acute cryptoglandular anorectal abscesses. METHODS: Of 170 patien
ts without previous anal fistulas, 146 were followed up for an average
of 99 (range, 22-187) months after abscess drainage or until a fistul
a appeared. RESULTS: Fifty-four (37 percent) patients developed a fist
ula, and 15 (10 percent) patients developed a recurrent abscess. The i
ncidence of fistulas was higher in females than in males (50 vs. 31 pe
rcent; P = 0.0403), especially regarding anterior abscesses (88 vs. 33
percent). Abscesses growing Escherichia coli were more prone to fistu
la formation than those growing other bacteria (46 vs. 27 percent; P =
0.0368). CONCLUSION: Incision and drainage alone of acute anorectal a
bscesses is recommended, because an unnecessary primary fistulotomy ca
n be avoided in more than half of the patients by this approach. For s
uperficial anterior abscesses in females, however, primary fistulotomy
may be considered.