[Experience on the treatment of acute anorectal abscess with primary fistulotomy]

From August 1985 to July 1989, 72 cases with initial attacks of acute cryptoglandular anorectal abscesses were hospitalized and treated in Kuang Tien General Hospital. Among them were 52 cases of the perianal type, 8 of the intersphincteric type, 11 of the ischiorectal type and one case involving the supralevator space. Included were 62 males and 10 females (sex ratio 6:1) with a mean age of 39 years (range, 18 to 63). The mean duration of the follow-up was 24 months. Most anorectal abscesses originate from a cryptoglandular infection and are usually treated initially by incision and drainage. However, a fistula operation may be required if a fistula develops weeks or months later. Several published papers from various hospitals have also pointed out that this disease condition can be successfully treated by a one-stage operation-primary fistulotomy. In order to determine the source of infection, careful examination was carried out in the operating room under adequate anesthesia. A definite or at least a highly suspected offending crypt was found in 57 cases, all of whom were treated by primary fistulotomy. The remaining 15 cases whose offending crypts were undetectable, were treated by incision and drainage. Of the 57 cases treated with primary fistulotomy, four cases developed recurrent abscesses or fistulas. In the incision and drainage group, five cases developed recurrences. Among the nine cases of recurrence, five were of the ischiorectal type. The author surmises that acute anorectal abscess of the ischiorectal type was rarely cured by the one-stage primary fistulotomy operation. However, for the majority of perianal and intersphincteric abscesses, primary fistulotomy should be the first choice of management.