Surgical Outcomes of Emergent Perianal Abscess Treatment: Does Colorectal Specialization Matter?

Perianal abscess (PA) is a common surgical emergency. However, the role of colorectal specialization in intraoperative decision-making and postoperative outcomes for its management remains elusive. The aim of this study was to investigate the association between specialization and the management of PA.

We performed a retrospective analysis of a prospectively collected database of patients undergoing PA drainage during the period 2013-2023. The cohort was divided into two groups: patients treated by colorectal surgeons (CSs) and those who were treated by general surgeons (GSs). Demographic data, operative variables, and postoperative results were analyzed and compared between groups.

A total of 241 patients presented with a PA; 69 (28.6%) were operated by CS and 172 (71.4%) by GS. The detection rate of an underlying fistula was greater in the CS group compared to the GS group. Definitive treatment for fistulas was more frequent among CS (34.8% versus 16.8% P = 0.002). The need of a deferred procedure for fistula treatment (CS: 10.5% versus GS: 21.9%, P = 0.1), recurrence rate (CS: 5% versus GS: 12.2%, P = 0.2), readmissions (CS: 4.3% versus GS: 5.2%, P = 0.77), and reoperations rates (CS: 8.8% versus GS: 7.5% P = 0.7) were similar between groups. No differences were observed in the incontinence rate between groups (CS: 2.9% versus GS: 4.1%, P = 0.6).

Intraoperative diagnosis and definitive treatment of underlying fistula was more common among CSs. However, management of PA by GSs was not associated with increased PA recurrence rates or the need for deferred fistula treatments.