Is perianal sepsis adequately managed? The results of a five year audit at Royal Naval Hospital Haslar
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1RNH Haslar.
Abstract:
A retrospective audit and postal questionnaire of 148 patients presenting with perianal sepsis confirms that the isolation of gut-related organisms remains a sensitive indicator of a perianal fistula. It did not confirm that the use of microbiological results affects the long term outcome for these patients. It suggests that early examination under anaesthetic and laying open of a fistula may not be necessary in all patients in which gut-related organisms are identified. There was no statistical difference in recurrence rates of perianal sepsis between those operated on by senior or junior surgeons, though there may have been selection bias in these patients.
Insights
Identifying gut bacteria in perianal sepsis is a sensitive indicator of a fistula. However, microbiological results did not improve long-term outcomes, suggesting early surgical intervention may not always be needed.
Area of Science:
- Colorectal surgery
- Surgical microbiology
Background:
- Perianal sepsis is a common condition often associated with anal fistulas.
- Identifying causative organisms is crucial for guiding treatment strategies.
Purpose of the Study:
- To audit the diagnostic value of microbiological cultures in perianal sepsis.
- To assess the impact of microbiological results on long-term patient outcomes.
- To evaluate the necessity of early surgical intervention based on microbial findings.
Main Methods:
- Retrospective audit of 148 patients with perianal sepsis.
- Postal questionnaires were used to gather patient data.
- Analysis of microbiological results and treatment outcomes.
Main Results:
- Isolation of gut-related organisms was a sensitive indicator of perianal fistula.
- No significant difference in long-term outcomes was observed based on the use of microbiological results.
- No statistical difference in recurrence rates between patients operated on by senior or junior surgeons.
Conclusions:
- Microbiological identification of gut organisms is a sensitive marker for perianal fistulas.
- Current evidence does not support that microbiological results significantly alter long-term outcomes.
- Early surgical intervention (examination under anesthesia and laying open) may not be required for all patients with identified gut organisms.