Incision and drainage vs minimally invasive catheter drainage on pain and anal function in high perianal abscess patients

Abstract

BACKGROUND

Perianal abscess (PA) is a common and debilitating condition that requires prompt surgical intervention. Conventional incision and drainage, while standard, often results in significant postoperative pain, tissue trauma, and potential impairment of anal sphincter function, prompting the need for alternative approaches.

AIM

To compare the effect of incision and drainage with selective seton placement (ID) vs minimally invasive catheter drainage (MICD) on postoperative pain control and anal function preservation in patients with high PA.

METHODS

This retrospective study included 226 patients with high PA (defined as abscesses located above the levator ani muscle, confirmed by imaging) who underwent ID (n = 122) or MICD (n = 104). Primary outcomes were pain intensity identified using the visual analogue scale (preoperatively and on postoperative days 1, 7, and 14) and anal function according to Wexner score on postoperative day 30. Secondary outcomes included inflammatory cytokine levels [interleukin (IL)-4, IL-6, IL-10, and tumor necrosis factor-alpha], operative time, blood loss, wound healing time, and hospital stay. Anal fistula formation and abscess recurrence were evaluated as exploratory endpoints.

RESULTS

The MICD group demonstrated significantly lower visual analogue scale at all postoperative time points (all P < 0.001). A significantly higher proportion of patients in the MICD group achieved normal anal function (69.2% vs 48.4%, P = 0.002). On postoperative day 7, the MICD group showed lower levels of IL-4, IL-6, and tumor necrosis factor-alpha and higher levels of IL-10 (all P < 0.01). Operative time, blood loss, wound healing, and hospital stay were significantly reduced in the MICD group (all P < 0.01). Exploratory analysis showed a lower rate of anal fistula formation (8.7% vs 24.6%, P = 0.002) and abscess recurrence (3.8% vs 12.3%, P = 0.023) with MICD. However, these findings are limited by inherent differences in internal opening management between the techniques. Multivariate analysis identified MICD as a protective factor against anal incontinence (odds ratio = 0.334, P = 0.003), whereas diabetes and deep abscess were risk factors (both P < 0.01).

CONCLUSION

MICD is associated with better postoperative pain control, better preservation of anal sphincter function, a more favorable anti-inflammatory response, and faster recovery than conventional ID in patients with high PA. The potential benefit regarding fistula risk reduction requires further validation in prospective studies with standardized internal opening protocols.

Keywords: Perianal abscess; Incision and drainage; Minimally invasive catheter drainage; Pain; Anal function

Core Tip: This retrospective study compared incision and drainage with selective seton placement vs minimally invasive catheter drainage (MICD) for high perianal abscesses. MICD demonstrates significant advantages in reducing postoperative pain and preserving anal sphincter function. Notably, the observed lower fistula rate with MICD is confounded by differing intraoperative management of the internal opening between techniques. These findings support MICD as a promising, patient-centered alternative, though further validation with standardized protocols is required.