• Iatrogenic
• Postoperative
• Rectovaginal fistula
• Stoma
• Surgery

• Humans
• Female
• Retrospective Studies
• Rectovaginal Fistula/surgery
• Rectovaginal Fistula/etiology
• Middle Aged
• France
• Postoperative Complications/etiology
• Postoperative Complications/surgery
• Surgical Stomas/adverse effects
• Adult
• Aged
• Treatment Outcome
• Anastomosis, Surgical/adverse effects
• Anastomosis, Surgical/methods

• Université d'Angers

• aerobes
• anorectal abscess (ARA)
• anorectal fistula
• microbial spectrum

• Anal abscesses
• Crohn’s disease
• Fistula

• Humans
• Abscess/complications
• Abscess/diagnosis
• Retrospective Studies
• Escherichia coli
• Anus Diseases/complications
• Anus Diseases/surgery
• Rectal Fistula/complications
• Rectal Fistula/surgery
• Drainage/adverse effects
• Treatment Outcome

• Copenhagen University

• martius flap
• necrosis
• obstetric
• rectovaginal fistula
• vesicovaginal fistula

• Anorectal abscess
• Supralevator abscess

• Anal abscess
• Pelvic abscess
• Perirectal abscess
• Retrorectal abscess
• Supralevator abscess

• Humans
• Abscess/diagnosis
• Abscess/surgery
• Abscess/etiology
• Rectal Fistula/diagnosis
• Rectal Fistula/surgery
• Prospective Studies
• Retrospective Studies
• Drainage/adverse effects
• Sepsis/etiology

• abscess
• anal
• anorectal
• benign
• fistula
• incontinence

• Anorectal abscess
• Crohn’s disease
• Intra-abdominal abscess
• Phlegmon

• Cutaneous abscess
• Incision and drainage
• Packing; non-packing

• Abscess/surgery
• Adult
• Anus Diseases
• Bandages
• Child
• Drainage
• Humans
• Randomized Controlled Trials as Topic
• Rectal Fistula

Perianal fistulae strongly impact on quality of life of affected patients.

To challenge and novel minimally invasive treatment options are needed.

Patients with Crohn’s disease (CD) in remission and patients without inflammatory bowel disease (non-IBD patients) were treated with fistulodesis, a method including curettage of fistula tract, flushing with acetylcysteine and doxycycline, Z-suture of the inner fistula opening, fibrin glue instillation, and Z-suture of the outer fistula opening followed by post-operative antibiotic prophylaxis with ciprofloxacin and metronidazole for two weeks. Patients with a maximum of 2 fistula openings and no clinical or endosonographic signs of a complicated fistula were included. The primary end point was fistula healing, defined as macroscopic and clinical fistula closure and lack of patient reported fistula symptoms at 24 wk.

Fistulodesis was performed in 17 non-IBD and 3 CD patients, with a total of 22 fistulae. After 24 wk, all fistulae were healed in 4 non-IBD and 2 CD patients (overall 30%) and fistula remained closed until the end of follow-up at 10-25 mo. In a secondary per-fistula analysis, 7 out of 22 fistulae (32%) were closed. Perianal disease activity index (PDAI) improved in patients with fistula healing. Low PDAI was associated with favorable outcome (P = 0.0013). No serious adverse events were observed.

Fistulodesis is feasible and safe for perianal fistula closure. Overall success rates is at 30% comparable to other similar techniques. A trend for better outcomes in patients with low PDAI needs to be confirmed.

• Fistula
• Fibrin glue
• Crohn's disease
• Perianal disease activity index
• Inflammatory bowel disease
• Fistula closure

This pilot study aimed to document our results of treating anorectal abscesses with drainage plus loose seton for possible coexisting high fistulas or drainage plus fistulotomy for low tracts at the same operation.

Drainage plus fistulotomy were performed only in cases with subcutaneous mucosa, intersphincteric, or apparently low transsphincteric fistula tracts. For all other cases with high transsphincteric fistula or those with questionable sphincter involvement, a loose seton was placed through the tract. Drainage only was carried out in 17 patients.

Twenty-three patients underwent drainage plus loose seton. Drainage plus fistulotomy were performed in four cases. None of the patients developed recurrent abscess during a follow-up of 12 months. Not surprisingly, the incontinence scores were similar pre and post-operatively (p=0.564). Only minor complications occurred in 4 cases (14.8 percent). Secondary interventions following loose seton were carried out in 13 patients (48.1 percent). At 12 months, drainage only was followed by 10 recurrences (58.8 percent; p<0.0001, compared with concomitant surgery).

Concomitant loose seton treatment of high fistula tracts associated with anorectal abscess prevents abscess recurrence without significant complications or disturbance of continence. Concomitant fistulotomy for associated low fistulas also aids in the same clinical outcome. Concomitant fistula treatment with the loose seton may suffice in treating the whole disease process in selected cases. Even in patients with high fistula tracts, the loose seton makes fistula surgery simpler with a mature tract. Abscess recurrence is high after drainage only.

• Anorectal abscess
• fistula-in-ano
• seton

Perianal abscess is a common anorectal disease, mainly caused by anal gland infection. Abscess, once formed, should be timely treated. At present, there are many methods available to treat perianal abscess, but each of them has some shortcomings. According to the physiological and pathological mechanism of perianal abscess, we designed a new surgical method named three-cavity clearance (TCC) to maximize the protection of anal sphincter function and reduce the pain of patients.

To evaluate the safety and efficacy of TCC in perianal cryptoglandular abscess.

From January 2017 to January 2018, perianal abscess patients who underwent TCC at the Center for Anorectal Diagnosis and Treatment of the Second Affiliated Hospital of Nanjing University of Traditional Chinese Medicine were selected as a study group. Patients who underwent simple incision and drainage for perianal abscess during the same period were selected into a control group. The two groups were 1:1 paired with comparable age, sex, and abscess site. Hospitalization time, wound healing time, anal fistula formation rate, and anal incontinence were compared between the two groups.

There were 32 patients in each group and a total of 64 patients were included in this study. The formation rate of anal fistula in the TCC group was 6%, significantly lower than that in the control group (34.0%, P < 0.01). There was no anal incontinence in either group. The hospitalization time and wound healing time of the two groups showed no statistical difference (P > 0.05).

TCC for perianal abscess is a safe and complete anal sphincter preserving technique, which can effectively reduce the rate of postoperative anal fistula formation.

• Perianal abscess
• Three-cavity clearance
• Simple incision and drainage

Three-cavity clearance (TCC) is an innovative technique that completely preserves anal sphincter, which can effectively reduce the probability of postoperative anal fistula formation and the recurrence of abscess, has small trauma and a low risk, and deserves further promotion and study clinically. In this paper, we discuss the theoretical basis, clinical application, and related problems of TCC for perianal abscess.

• Perianal abscess
• Three-cavity clearance
• Theoretical basis
• Progress in clinical application

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Proper drainage of supralevantor abscess should be achieved for the fistulae path.

Supralevator abscess is the least common type of anorectal abscess. Its diagnosis can be hard and treatment difficult.

A 48-year-old men was diagnosed in the emergency department with a supralevantor abscess. Under general anaesthesia, the abscess drainage was accomplished after removal of a fish bone, who was perforating the rectum. Due to persistent rectal purulent discharge, a pelvic Magnetic Resonance (MRI) was performed: a supralevator abscess adjacent to the internal obturator muscle and an inter-sphincteric fistulae from the inferior margin of this collection were identified. A Pezzer® drain was placed through the fistula tract. After radiological resolution, under general anaesthesia, the patient was submitted to extraction of the drain and marsupialization of the path left using an ENDO GIA®. At two year follow up he remained asymptomatic.

Despite of the abscess aetiology, the principles of treatment are the same: good radiological characterization and proper drainage. An adequate radiological characterization is important to avoid iatrogenic creation of a complex fistulae.

If a supralevator abscess diagnosis is made, fistulae trajectory should be studied. If no clear internal opening is evident, a pelvic MRI should be done followed by drainage of the abscess. After resolution the drain should be taken off and marsupialization with ENDO GIA® should be performed.

• Case report
• Mechanic fistulae tract marsupialization
• Supralevantor abscess

• Emergency Treatment/standards
• Humans
• Needs Assessment
• Practice Guidelines as Topic
• Societies, Medical
• Surgical Procedures, Operative/standards
• Traumatology/standards

• CT scan
• Drainage
• Mini-invasive
• Supralevator abscess

• Abscess/diagnostic imaging
• Abscess/surgery
• Adult
• Anal Canal/diagnostic imaging
• Anal Canal/surgery
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Minimally Invasive Surgical Procedures
• Tomography, X-Ray Computed

• ligature method
• seton
• seton drainage

• anal disorders
• anal fistula
• fistula-in-ano
• fistulectomy
• guidelines

Skin abscesses are a frequent encountered health care problem and lead to a significant source of morbidity. They consequently have an essential impact on the quality of life and work. To date, the type of aftercare for surgically drained abscesses remains under debate. This leads to undesirable practice variations. Many clinical standard protocols include sterile wound dressings twice a day by a home-care service to reduce the chance of a recurrent wound infection. It is unknown, however, whether reinfection rates are comparable to adequate wound irrigation with a nonsterile solution performed by the patient. Our hypothesis is that simple wound irrigation with nonsterile water for postoperative wound care after an abscess is surgically drained is feasible. We assume that in terms of reinfection and reintervention rates unsterile wound irrigation is equal to sterile wound irrigation.

The primary aim of this study is therefore to investigate if there is a need for sterile wound irrigation after surgically drained spontaneous skin abscesses.

In a prospective, randomized controlled, single-blinded, single-center trial based on a noninferiority design, we will enroll 128 patients randomized to either the control or the intervention group. The control group will be treated according to our current, standard protocol in which all patients receive a sterile wound irrigation performed by a home-care service twice a day. Patients randomized to the intervention group will be treated with a nonsterile wound irrigation (shower) twice a day. All patients will have a routine clinical control visit after 1, 3, 6, and 12 weeks in the outpatient clinic. Primary outcome is the reinfection and reoperation rate due to insufficient wound healing diagnosed either at the outpatient control visit or during general practitioner visits. Secondary outcome measures include a Short Form Health Survey, Visual Analog Scale, Patient and Observer Scar Assessment Scale, Vancouver Scar Scale, and the EurolQol 5-Dimension Questionnaire. Those questionnaires will be completed at the outpatient control visits.

The trial was started in June 2016 and enrolled 50 patients by article publication. Regarding the adherence to our protocol, we found 10% of loss to follow-up until now. Only 2 patients needed reoperation and only 1 patient needed a change of treatment (antiseptic therapy). Most patients are happy with their randomized treatment but as expected some patients in the sterile group complained about timing problems with their working hours and home-care service appointments. Most patients in the nonsterile group are satisfied being able to take care of their wounds independently although some patients still depend on the home-care service for the wound dressing. We are hoping to have enrolled enough patients by summer 2017. The follow-up will take until autumn 2017, and study results are expected to be published by the end of 2017. This trial is solely supported by the cantonal hospital of Lucerne.

Nonsterile wound irrigation is more likely to be carried out independently by the patient than sterile wound irrigation. Therefore, if nonsterile wound care shows comparable results in terms of reinfection and reintervention rates, patient independence in the aftercare of surgically drained abscesses will increase, patients can return to work earlier, and health care costs can be reduced. In a preliminary, conservative estimation of health care costs, an annual savings of 300,000 CHF will be achieved in our hospital.

German Clinical Trials Register DRKS00010418; https://drks-neu.uniklinik-freiburg.de/ drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00010418 (Archived by WebCite at http://www.webcitation.org/6q0AXp5EX)

• aftercare
• recurrent infection
• skin and soft-tissue infections
• surgical draining of abscesses
• wound irrigation

• Anal abscess
• Anal fistula
• Diagnostic
• Fecal incontinence
• Fistula-in-ano
• Operative treatment

Perianal abscess which can lead to a devastating complications. The management of perianal abscess involves incision and drainage by different methods one of them is packing the cavity.

The aim is using Corrugate Rubber drain as an alternative to other methods.

This study was an observational retrospective review of 137 'case series' of patients with perianal abscess over a fifteen-year period from January 2000 to December 2015. 67 patients in group A were managed by Corrugated Rubber drain and 70 patients in group B were managed by packing. In group A, males were 92.53% more than females (7.46%) while group B, males were 85.71% and the rest were females. Outcome measures were assessed; time to cavity healing, pain scoring, abscess recurrence, fistula formation, analgesic requirement and skin disfigurement.

The mean time of abscess healing in group A and B were 8.50 ± 0.49 and 8.90 ± 0.23 days respectively. Their pain score using Corrugate Rubber drain postoperative were 2/10 in group A while group B was 8/10. Most of patients in group A needed mild analgesia (52/67) (77.61%). The rate of abscess recurrence and fistula development were (22/67) (32.83%) and (21/67) (31.34%) respectively in group A which is significantly lower than group B.

Management of perianal abscess using Corrugate Rubber drain in compares with packing leads to immediate pain relief, low recurrence rate of abscess and fistula formation, without need to expert nursing and less ugly scar formation. This resulted in low morbidity and cost.

•

Management of perianal abscess involves cruciate incision over the abscess and drainage by using Corrugate Rubber drain as another method of drainage and an alternative to other methods like packing by assessing healing of perianal abscess, recurrence and fistula development.

• Corrugate
• Drain
• Packing
• Perianal abscess

• Abscess/surgery
• Anus Diseases/etiology
• Anus Diseases/therapy
• Bandages
• Drainage
• Humans
• Postoperative Complications/therapy
• Randomized Controlled Trials as Topic
• Rectal Fistula/etiology
• Rectal Fistula/therapy
• Self Care
• Time Factors
• Wound Healing

• 13/89/08 Department of Health
• 8975 Cancer Research UK

• Abscess
• Anal fistula
• Complex
• Horseshoe
• Simple
• Supralevator
• Tracts

• Perianal abscess
• Prevalence
• Readmission
• Risk factor
• Sweden

• Perianal glands
• abscess
• recurrence

Perianal abscess is a common disease. Due to the special anatomical position, management of perianal abscess is still controversial. Especially, the treatment of deep perianal abscess is very difficult, because it is difficult to confirm the relationship among internal opening, extent of deep anorectal abscess and anorectal sphincters. Correct treatment of the internal opening and extent of deep anorectal abscess is the key to success. Treating the fistula and the abscess at the same time by incision and drainage may reduce the likelihood of recurrent abscess and the need for repeat surgery. However, this could affect sphincter function in some patients who may not later develop a fistula-in-ano. The results of current treatments for perianal abscess are not very satisfactory. More studies are needed in future.

• Perianal abscess
• Diagnosis
• Operative treatment

• Anal abscess
• Anal fistula
• Endorectal advancement flap
• Fistulizing Crohn disease
• Fistulotomy
• LIFT procedure