Antibiotic therapy for prevention of fistula in-ano after incision and drainage of simple perianal abscess: A randomized single blind clinical trial

Ghahramani, Leila; Minaie, Mohammad Reza; Arasteh, Peyman; Hosseini, Seyed Vahid; Izadpanah, Ahmad; Bananzadeh, Alimohammad; Ahmadbeigi, Mahboobe; Hooshanginejad, Zahra

doi:10.1016/j.surg.2017.07.001

Cited by 47 publications

(41 citation statements)

References 19 publications

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“…The use of antibiotics for reducing the incidence of anal fistula after incision and draining has remained to be established . Our findings collectively provided clinical evidences to support the notion that targeting IL‐17 would be a potential approach for treatment of perianal abscess and anal fistula.…”

Section: Discussionsupporting

confidence: 65%

Role of interleukin‐17 in the pathogenesis of perianal abscess and anal fistula: a clinical study on 50 patients with perianal abscess

Wang

Cheng

et al. 2018

ANZ Journal of Surgery

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Background: To investigate the role of interleukin (IL)-17 in tissue and peripheral blood of perianal abscess and anal fistula. Methods: Patients with primary perianal abscess (n = 50) admitted to Jinhua Municipal Central Hospital between March 2003 and August 2004 were enrolled. Fifty patients with mixed haemorrhoids, who showed no perianal abscess or anal fistula, were also recruited as the control. After surgery, patients were followed up for 6 months. Protein and gene expression of IL-17 was determined in surgically harvested anal tissues and peripheral blood, respectively. The relationship between IL-17 and clinical pathological features were analysed. Results: As shown by immunohistochemistry of anorectal tissues, the positive rate of IL-17 protein was higher in the perianal abscess group than in the control group. In patients with perianal abscess, the expression of IL-17 significantly correlated with the diameter of the abscess (P = 0.013), the wound surface healing time (P = 0.010) and the progression into anal fistula (P = 0.003). For the gene expression of IL-17 in peripheral blood cells, the level was significantly higher in patients with perianal abscess comparing to the control group (0.4350 AE 0.1190 versus 0.1785 AE 0.1230, P ≤ 0.001). Comparing to the recovery group, patients with their perianal abscess progressed to anal fistula showed higher levels of IL-17 gene expression (P = 0.014). Conclusions: Expression of IL-17 was increased in the anorectal tissues and peripheral blood of patients with perianal abscess and anal fistula. IL-17 may play an important role in the pathogenesis of perianal abscess and anal fistula.

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Section: Discussionsupporting

confidence: 65%

Role of interleukin‐17 in the pathogenesis of perianal abscess and anal fistula: a clinical study on 50 patients with perianal abscess

Wang

Cheng

et al. 2018

ANZ Journal of Surgery

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“…Another limitation was the lack of a placebo for the control group; however, the blinded surgeon was performing clinical outcome assessment, therefore the impact of a placebo effect, although unknown, is presumably small. 1,2 Finally, we do not know if the 2 study groups were similar at the onset of the trial, as the baseline characteristics of study participants were not stratified by treatment group, as is customary in all randomized controlled trials.…”

Section: Discussion En Chirurgie E364mentioning

confidence: 99%

“…However, a great deal about the pathogenesis and development of fistulas of cryptoglandular origin remains unknown. The study by Ghahramani and colleagues 1 does not address which patients would benefit most from antibiotic treatment, and in the era of antibiotic stewardship and resistant organisms one has to ponder whether treating all patients with antibiotics is an appropriate approach. However, given that fistulae can be quite difficult to treat, it can be argued that any intervention to reduce the risk of fistula formation is likely a good strategy.…”

Section: Discussion En Chirurgie E364mentioning

confidence: 99%

“…At the same time, most of the literature has focused on surgical management of fistulae; however, if we could prevent fistula formation, multiple surgeries to treat this vexing problem could be avoided. This is the question posed by Ghahramani and colleagues, 1 who report the results of their randomized single-blind superiority trial of antibiotics to prevent the formation of fistula. The authors sought to include 150 patients in each arm of the study, which was based on a baseline rate of 32% and a detection rate of an absolute difference of 15%.…”

Section: Commentarymentioning

confidence: 99%

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Does antibiotic therapy prevent fistula in-ano after incision and drainage of simple perianal abscess?

Brar

Remzi

Warusavitarne

et al. 2020

CJS

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The term "evidence-based medicine" was first coined by Sackett and colleagues as "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients." The key to practising evidence-based medicine is applying the best current knowledge to decisions in individual patients. Medical knowledge is continually and rapidly expanding. For clinicians to practise evidence-based medicine, they must have the skills to read and interpret the medical literature so that they can determine the validity, reliability, credibility and utility of individual articles. These skills are known as critical appraisal skills, and they require some knowledge of biostatistics, clinical epidemiology, decision analysis and economics, and clinical knowledge. Evidence-based Reviews in Surgery (EBRS) is a program jointly sponsored by the Canadian Association of General Surgeons (CAGS) and Medtronic. The primary objective of EBRS is to help practising surgeons improve their critical appraisal skills. During the academic year, 9 clinical articles are chosen for review and discussion. They are selected for their clinical relevance to general surgeons and because they cover a spectrum of issues important to surgeons, including causation or risk factors for disease, natural history or prognosis of disease, how to quantify disease, diagnostic tests, early diagnosis and the effectiveness of treatment. A methodological article guides the reader in critical appraisal of the clinical article. Methodological and clinical reviews of the article are performed by experts in the relevant areas and posted on the EBRS website, where they are archived indefinitely. In addition, a listserv allows participants to discuss the monthly article. Surgeons who participate in the monthly packages can obtain Royal College of Physicians and Surgeons of Canada Maintenance of Certification credits and/or continuing medical education credits (for the current article only) by reading the monthly articles, participating in the listserv discussion, reading the methodological and clinical reviews and completing the monthly online evaluation and multiple-choice questions. We hope readers will find EBRS useful in improving their critical appraisal skills and in keeping abreast of new developments in general surgery. Reviews are published in condensed versions in the

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“…Conservative management of perianal abscess with antibiotic therapy appears to play a role in infants given the high rate of spontaneous resolution ( 1 ). However, in children older than 2 years of age, many surgeons recommend surgical drainage of perianal abscesses followed by post-operative antibiotics given the high risk of recurrent infections and development of fistula-in-ano following conservative management ( 1 , 3 – 5 , 7 ). It is important to consider that although this process most commonly is associated with cryptoglandular infection; inflammatory bowel disease, perianal/perirectal masses, and gastrointestinal (GI) duplications may present similarly ( 9 – 12 ).…”

Section: Introductionmentioning

confidence: 99%

Congenital Perirectal Dermoid Cyst: A Rare Cause of Complex, Recurrent Pediatric Fistula-in-ano

et al. 2018

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Perianal abscess and fistula-in-ano are well-described in the pediatric population. They are most common in infants less than 1 year of age and often resolve with oral antibiotics; occasionally they require drainage or fistulotomy. The etiology is commonly associated with cryptoglandular obstruction and subsequent infection, however alternative diagnoses should be considered in cases of recurrent abscesses and fistulae that are refractory to standard treatments. In this report, we present the case of an 8-year-old boy with a complex, recurrent fistula-in-ano that resulted from a rare congenital perirectal dermoid cyst.

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Antibiotic therapy for prevention of fistula in-ano after incision and drainage of simple perianal abscess: A randomized single blind clinical trial

Cited by 47 publications

References 19 publications

Role of interleukin‐17 in the pathogenesis of perianal abscess and anal fistula: a clinical study on 50 patients with perianal abscess

Role of interleukin‐17 in the pathogenesis of perianal abscess and anal fistula: a clinical study on 50 patients with perianal abscess

Does antibiotic therapy prevent fistula in-ano after incision and drainage of simple perianal abscess?

Congenital Perirectal Dermoid Cyst: A Rare Cause of Complex, Recurrent Pediatric Fistula-in-ano

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