Early reoperation for perirectal abscess - A preventable complication

PURPOSE: The aim of this study was to analyze failures in the operative man agement of perirectal abscesses resulting in early reoperation. METHODS: Th is was a retrospective case study of 500 consecutive patients who underwent 627 drainage procedures for a perirectal abscess. RESULTS: Forty-eight pat ients (7.6 percent of all drainage procedures) required reoperation within ten days of the original procedure. The main factors leading to reoperation were incomplete drainage (23 patients), missed loculations within a draine d abscess (15 patients), missed abscesses (4 patients), and postoperative b leeding (3 patients). Incomplete drainage was more common with simple perir ectal abscesses, whereas most overlooked collections were located posterior ly. Horseshoe abscesses were associated with a particularly high rate (50 p ercent) of operative failures. Neither preexisting perianal pathology nor s ystemic immunosuppressive disease contributed to early failures. CONCLUSION : Surgical errors are the leading cause of early failures in the surgical t reatment of perianal abscesses. These errors occur in a limited number of t ypical patterns and can therefore be identified and taught with an aim to d ecrease their occurrence.