Concomitant anal fistulotomy (F) and incision and drainage (I&D) of is
chiorectal abscesses (IA) are often avoided, for fear of irreversibly
impairing anal continence, However, failure to identify and treat the
frequently associated trans-sphinteric anal fistula dooms the patient
to recurrent anal suppurative disease, We have employed an aggressive
approach of performing I&D and F for IA at the time of initial present
ation. Adequate drainage is assumed by placement of counterincisions a
nd Penrose drains to minimize the time for healing of the perianal wou
nd, Drainage is followed by a careful examination of the anal canal fa
r fistula localization followed by fistulotomy, or less frequently by
cutting seton placement, We present our experience with this approach
to IA, with special attention paid to the evaluation of recurrence rat
es and anal continence. This paper represents a retrospective review o
f 80 patients with IA managed from 1983 to 1996. Operative records and
office records were reviewed, and follow-up data were obtained by tel
ephone interview. Internal fistulous openings were identified in 55 (6
8.8%) patients. Surgeries included: 38 (47.5%) I&D and F, 8 (10%) I&D
and seton, and 34 (42.5%) I&D alone, Follow-up data were available on
99 per cent of patients; mean, 44.3 months, Results showed a 44 per ce
nt recurrence rate In those who underwent I&D as compared with 21.1 pe
r cent Following I&D and F, 11.8 per cent of patients treated with IBD
experienced a change in their level of continence postoperatively as
compared to 15.8 per cent treated with I&D and F, TI-re results indica
te that an aggressive approach to IA allows identification oi: a trans
-sphincteric fistula in 57.5 per cent of patients with IA. Therefore,
optimal surgical management for IA appears to be I&D and F, resulting
in a lower recurrence rai-e and comparable morbidity as compared to I&
D alone.