Influence of adjuvant antibiotics on fistula formation following incision and drainage of anorectal abscesses: a systematic review protocol

Baker, Laura; Williams, Lara; Winter, Remington; Cahill, Caitlin; Davis, Alexandra; Fergusson, Dean

doi:10.1186/s13643-019-1002-z

Cited by 6 publications

(3 citation statements)

References 19 publications

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“…Multiple hypotheses exist. On the one hand, some believe that a course of antibiotics following drainage will reduce the odds of developing a fistula tract by eradicating residual infection especially in patients over 45 years [15]; but on the other hand, the results of a randomized trial reported opposing conclusions [16] which only highlights the need of a systematic review of the available literature in order to propose clear guidelines regarding the use of antibiotics following the drainage of a perianal abscess [17]. In this study, no association between the use of antibiotics and the risk of developing a fistula or a recurrence of the abscess was found.…”

Section: Discussionmentioning

confidence: 99%

Incidence of anal fistula after pyogenic perianal abscess drainage in Kingdom of Bahrain

et al. 2023

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Perianal fistula is one of the most common anorectal diseases in adult patients, especially men. A relationship between pyogenic perianal abscess and fistula formation is established in multiple domains. This is the first exploration of such association among patients in the country as no related study has been published in Bahrain. We expect this study to be a foundation for future protocols and evidence-based practice. Methods: A retrospective study was conducted in Salmaniya Medical Complex of Bahrain. A total of 109 patients with a diagnosis of anal abscess were included between 2015 and 2018. Data were collected from the electronic files database used in Salmaniya Medical Complex (iSeha) as well as phone calls to the patients. Collected data were analyzed using statistical software. Results: The most predominant presentation of perianal abscess was pain. Over 50% of abscesses were classified as perianal (56.9%) and among those, left-sided abscesses were more common, followed by right-, posterior-, and anterior-sited, respectively. No recurrence of abscess was recorded among 80% of patients. A fistula developed following abscess drainage in 33.9% of patients. Most fistulas (37.8%) were diagnosed within 6 months or less from abscess drainage. Posterior fistulas were the most common, followed by anterior and left-sided fistulas. Conclusion: The incidence of anal fistula in Bahrain after perianal abscess was 33.9%. Most of the patients who developed a fistula following pyogenic abscess drainage were males and above the age of 40 years. The most common site for fistula was posterior.

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Section: Discussionmentioning

confidence: 99%

Incidence of anal fistula after pyogenic perianal abscess drainage in Kingdom of Bahrain

et al. 2023

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“…In this case, the incisions were made at the sites of most fluctuance, and the abscess cavities were allowed to drain. Although there is no substantial evidence to support continued antibiotic use after drainage of perianal abscesses [ 15 ], authors recommend continued antibiotics in the immediate post-operative period in these rare scenarios, especially if systematic signs of infection such as fever are present.…”

Section: Discussionmentioning

confidence: 99%

Perianal Abscess Following Excisional Hemorrhoidectomy in an Immunocompetent Patient

Olmedo¹,

Lee²

2022

Cureus

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Hemorrhoidal disease is the third most common outpatient gastrointestinal diagnosis affecting more than four million patients annually. The management depends on the disease severity, and the treatment options range from lifestyle modification to excisional hemorrhoidectomy. Perianal abscess is an exceedingly rare complication following hemorrhoidectomy, with immunocompromised patients the most commonly affected. The rarity of this complication may be attributed to the natural immunologic process within the reticuloendothelial apparatus of the liver. The disease presentation of perianal abscess after hemorrhoidectomy and its management is unclear in the literature. We present the case of a 44-year-old immunocompetent male with grade II and III hemorrhoidal disease who underwent excisional hemorrhoidectomy that was complicated with perianal abscesses. The patient was successfully managed with incision and drainage with antibiotics. Surgeons should maintain a high index of suspicion for any sign of pelvic sepsis or a developing perianal abscess, particularly in immunocompromised patients.

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“…The Anglo-Saxon school, on the other hand, advocates simple incision in cases of a first abscess on the grounds that more than 60% of patients do not experience recurrence [2]. Moreover, recent literature suggests the utility of administration of an antibiotic after incision of a perianal abscess [3]. Indeed, predictive factors for the recurrence of abscesses have been reported, such as age, female gender, fever, high BMI, intake of corticosteroids, diabetes, and Crohn's disease (CD) [4][5][6]7].…”

Section: Introductionmentioning

confidence: 99%

Perianal abscess after incision: is it time to rethink our practice?

Alam,

Fathallah,

Aubert

et al. 2024

Preprint

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Background Perianal abscess management varies between the French and Anglo-Saxon schools, with the former advocating immediate fistula treatment to prevent recurrence, while the latter suggests simple incision due to a purported low recurrence rate. This study aimed to evaluate the outcomes and predictive factors associated with perianal abscess management in our department. Methods In 2019, 109 patients presenting with a first perianal abscess were included in the study, excluding those with specific criteria. Treatment involved incision under local anesthesia, possibly combined with antibiotic therapy using amoxicillin/clavulanic acid for five days. Patients with obvious signs of fistula were scheduled for immediate surgery. The primary objective was to assess the rate of patients requiring surgical management of fistula and/or experiencing abscess recurrence, with secondary objectives including the identification of predictive factors. Results Among the 336 patients who consulted for an abscess, 109 were included, with a mean age of 43 years and 74% being men. Of these, 55 underwent incision alone, while 54 had anal fistula surgery after incision. The mean follow-up for patients with incision alone was approximately 30 months, during which 18% experienced abscess recurrence. Univariate logistic regression analysis revealed smoking and absence of antibiotic therapy post-incision as predictive of recurrence. Gender, age, BMI, diabetes, Crohn's disease, HIV infection, prior NSAID use, and abscess location were not predictive. Multivariate analysis was not conducted due to insufficient data. Conclusions This study demonstrates that 41% of patients who underwent incision for a first perianal abscess did not experience recurrence during the follow-up period. Additionally, the administration of antibiotic therapy post-incision was associated with a reduced likelihood of recurrence. However, randomized trials are warranted to validate these findings and specify the optimal antibiotic regimen.

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Influence of adjuvant antibiotics on fistula formation following incision and drainage of anorectal abscesses: a systematic review protocol

Cited by 6 publications

References 19 publications

Incidence of anal fistula after pyogenic perianal abscess drainage in Kingdom of Bahrain

Incidence of anal fistula after pyogenic perianal abscess drainage in Kingdom of Bahrain

Perianal Abscess Following Excisional Hemorrhoidectomy in an Immunocompetent Patient

Perianal abscess after incision: is it time to rethink our practice?

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