Perianal abscess: a pilot study comparing packing with nonpacking of the abscess cavity

Perianal sepsis is traditionally treated by incision and drainage, with packing of the residual cavity until healing. This study was designed to show that perianal abscess may be safely treated by incision and drainage alone.

Healing times, analgesic requirements, pain scores, abscess recurrence, and fistula rates were compared between two randomized groups treated with and without packing of perianal abscess cavities.

Fifty patients were recruited (7 lost to follow-up): 20 in the packing and 23 in the nonpacking arm. The groups were comparable in terms of age and gender distribution, type and size of abscess, and the presence of a fistula at operation. Mean healing times were similar ( P = 0.214). The rate of abscess recurrence was similar ( P = 0.61). Postoperative fistula rates were similar ( P = 0.38). Pain scores at the first dressing change were similar ( P = 0.296). Although pain scores appeared much reduced in the nonpacking arm, this did not attain statistical significance.

Our pilot study indicates that perianal abscesses can be managed safely without continued packing of the cavity without any obvious complications.