Management of Anorectal Abscesses: Comparison Between Traditional Incision and Packing and De Pezzer Catheter Drainage

Abstract

This study compares the results of de Pezzer catheter drainage of anorectal abscess with the more traditional technique of incision and packing. A prospective study from this department in 1987 detailed the outcome of patients with anorectal abscess managed routinely by de Pezzer catheter drainage. Ninety-one patients were treated, 18 required general anaesthesia, the mean hospital stay was 1.4 days, and 24% subsequently required fistula surgery. A retrospective ~tudy has now been undertaken of all patients admitted to Wellington Hospital with anorectal abscess during the same period who were treated by incision and packing. Of 54 patients treated, all had general anaesthesia, the mean hospital stay was 4.5 days, 63% needed district nursing care after discharge and 25% required fistula surgery. Simple de Pezzer drainage is not only safe, convenient and well tolerated by patients, but it compares very favourably with the more traditional method of treating anorectal abscesses and, as a consequence of the minimal hospital care necessary, it must necessarily be a much cheaper method of treatment.

Multicentre observational study of outcomes after drainage of acute perianal abscess

“…Management of acute perianal sepsis has remained unchanged for over 50 years, and comprises surgical incision and drainage followed by continued internal wound dressing (packing) of the wound cavity until healed. Drainage under local anaesthesia and catheter drainage, suturing the cavity and postprocedural sitz baths have been investigated, but no evidence exists for their use.…”

S3-Leitlinie: Analabszess

“…Eine mikrobiologische Untersuchung ist in den meisten Fällen nicht erforderlich, da es keine therapeutische Konsequenz gibt. In älteren Studien findet sich als Alternativverfahren die Inzision in Narkose mit Einlage einer Lasche überwiegend in lokaler Betäubung [43,44,50]. Alle Publikationen stammen jedoch aus der gleichen Klinik.…”

Perianal Abscess: A Pilot Study Comparing Packing With Nonpacking of the Abscess Cavity

“…The authors indicate that the de Pezzer catheter was well tolerated and compared favorably with the traditional technique, with a reduced requirement for general anesthesia and district nursing after care. 11 This information indicates that abscess cavities can be managed without the use of cavity dressings without an increase in complication rates. However, in many hospitals continued packing is recommended.…”

“…In 1990, Kyle and Isbister 11 retrospectively compared the use of a de Pezzer catheter with traditional incision and drainage. The authors indicate that the de Pezzer catheter was well tolerated and compared favorably with the traditional technique, with a reduced requirement for general anesthesia and district nursing after care.…”