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Packing versus mushroom catheters following incision and drainage in anorectal abscess

  • Dan Annie Zhu
  • Lena Mary Houlihan
  • Helen M. MohanEmail author
  • Morgan McCourt
  • Emmet Andrews
Original Article
  • 9 Downloads

Abstract

Purpose

Management of anorectal abscess is traditionally by incision and drainage with packing. This study assessed the use of mushroom catheters compared with packing of anorectal abscess after incision and drainage in adults. Placement of a mushroom catheter to allow ongoing drainage of the cavity may have advantages by eliminating the need for painful dressing changes.

Methods

This was a retrospective observational study. Following ethical approval, a chart review of 167 patients treated for anorectal abscess with either packing or mushroom catheter at Cork University Hospital from 2010 to 2015 was performed. Treatment decision was based on individual surgeon preference. Outcome measures included recurrence and fistula development. Telephone follow-up was also performed to assess patient satisfaction and quality of life (EQ-5D-3L).

Results

One hundred and twenty-nine patients were treated with incision and drainage with packing, and 38 patients were treated with mushroom catheter. There was no statistically significant difference in recurrence (p = 0.691) or fistula development (p = 0.299) between the groups. Twenty-three patients had Crohn’s disease, 17 patients had diabetes and 66 patients were smokers. There was no statistically significant difference in recurrence or fistula development between the treatment groups in Crohn’s (p = 0.493), diabetics (p = 0.949) and smokers (p = 0.275). On average, patients treated with mushroom catheter reported a statistically significant higher satisfaction score (9.2 ± 1.0) than patients treated with packing (7.6 ± 1.8, p = 0.013).

Conclusion

Mushroom catheter drainage of anorectal abscesses is a safe alternative to traditional packing and results in higher patient satisfaction. This study provides a rationale for a future randomised controlled trial.

Keywords

Anorectal abscess Incision and drainage Mushroom catheter Packing Perianal abscess 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethics approval was obtained from the Clinical Research Ethics Committee of the Cork Teaching Hospital (CREC). This was a retrospective chart review with telephone follow-up of patients following informed consent. This article does not contain any studies with human participants performed by any of the authors as the only interventions performed were as part of routine care and not altered by the study.

Informed consent

Informed consent was obtained from all individual participants who participated in telephone follow-up included in the study.

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Copyright information

© Royal Academy of Medicine in Ireland 2019

Authors and Affiliations

  • Dan Annie Zhu
    • 1
    • 2
  • Lena Mary Houlihan
    • 1
  • Helen M. Mohan
    • 1
    Email author
  • Morgan McCourt
    • 1
  • Emmet Andrews
    • 1
    • 2
  1. 1.Department of SurgeryCork University HospitalCorkIreland
  2. 2.School of MedicineUniversity College CorkCorkIreland

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