Management of perianal sepsis in immunosuppressed patients

Despite improvements in the supportive care of immunosuppressed patients co ntroversy still surrounds the surgical management and outcome of anorectal sepsis in these patients. We reviewed 83 immunocompromised patients with di agnosis of perianal sepsis from 1995 to 1997. Sixty-six patients (80%) were followed for a mean of 25 months. Mean age was 44 years and 76 per cent we re males. Twenty-eight per cent were HIV+, 34 per cent had inflammatory bow el disease on steroids, 20 per cent had malignancies, and 18 per cent had d iabetes. Twenty-eight per cent had anal fistula, 2 per cent had perianal ab scess, and 40 per cent had both. Primary sites of fistula were: transsphinc teric (38%), intersphincteric (33%), superficial (20%), and suprasphincteri c (3%), and multiple tracks (6%). Horseshoeing was present in 14 per cent o f cases. The most commonly practiced surgical procedures were primary fistu lotomy (n = 23) and fistulotomy plus drainage (n = 28). Seven patients unde rwent fistulotomy and ostomy and eight patients were treated with fistulect omy plus drainage. Most wounds (91%) healed within 8 weeks. Incontinence (6 %) and recurrence (7%) were the most commonly observed complications. These results are similar to those seen in the general population. Perianal seps is can be safely managed in immunocompromised patients, with high rates of healing and low complication rates. An aggressive sphincter-preserving appr oach in the management of these patients may be undertaken.