Diseases of the Colon & Rectum

, Volume 41, Issue 11, pp 1357–1361 | Cite as

Incidence of fistulas after drainage of acute anorectal abscesses

  • Kari-Pekka J. Hämäläinen
  • A. Peter Sainio
Original Contributions


PURPOSE: The aim of this study was to assess the incidence of anal fistulas and factors related to this incidence after incision and drainage of acute cryptoglandular anorectal abscesses. METHODS: Of 170 patients without previous anal fistulas, 146 were followed up for an average of 99 (range, 22–187) months after abscess drainage or until a fistula appeared. RESULTS: Fifty-four (37 percent) patients developed a fistula, and 15 (10 percent) patients developed a recurrent abscess. The incidence of fistulas was higher in females than in males (50vs. 31 percent;P=0.0403), especially regarding anterior abscesses (88vs. 33 percent). Abscesses growingEscherichia coli were more prone to fistula formation than those growing other bacteria (46vs. 27 percent;P=0.0368). CONCLUSION: Incision and drainage alone of acute anorectal abscesses is recommended, because an unnecessary primary fistulotomy can be avoided in more than half of the patients by this approach. For superficial anterior abscesses in females, however, primary fistulotomy may be considered.

Key words

Anorectal abscess Anal fistula Surgical treatment 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Parks AG. Pathogenesis and treatment of fistula-in-ano. BMJ 1961;1:463–9.Google Scholar
  2. 2.
    Scoma JA, Salvati EP, Rubin RJ. Incidence of fistulas subsequent to anal abscesses. Dis Colon Rectum 1974;17:357–9.PubMedGoogle Scholar
  3. 3.
    Schouten WR, van Vroonhoven TJ. Treatment of anorectal abscess with or without primary fistulectomy: results of a prospective randomized trial. Dis Colon Rectum 1991;34:60–3.CrossRefPubMedGoogle Scholar
  4. 4.
    Vasilevsky C-A, Gordon PH. The incidence of recurrent abscesses or fistula-in-ano following anorectal suppuration. Dis Colon Rectum 1984;27:126–30.PubMedGoogle Scholar
  5. 5.
    Tang C-L, Chew S-P, Seow-Choen F. Prospective randomized trial of drainage alonevs. drainage and fistulotomy for acute perianal abscesses with proven internal opening. Dis Colon Rectum 1996;39:1415–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Seow-Choen F, Leong AF, Goh HS. Results of a policy of selective immediate fistulotomy for primary anal abscess. Aust N Z J Surg 1993;63:485–9.PubMedGoogle Scholar
  7. 7.
    Weber E, Buchmann P. Eröffnung anorectaler Abscesse—mit oder ohne Fistelspaltung? Chirurg 1982;53:270–2.PubMedGoogle Scholar
  8. 8.
    Ramstead KD. Do anal abscesses lead to fistulae-in-ano? Br J Clin Pract 1983;37:58–60.PubMedGoogle Scholar
  9. 9.
    Wilson DH. The late results of anorectal abscess treated by incision, curettage, and primary suture under antibiotic cover. Br J Surg 1964;51:828–31.PubMedGoogle Scholar
  10. 10.
    Athanasiadis S, Fischbach N, Heumüller L, Marla B. Abscessexcision und primäre Fistulektomie als Initialtherapie des periproktitischen Abscesses: eine prospektive Analyse bei 122 Patienten. Chirurg 1990;61:53–8.Google Scholar
  11. 11.
    Buchan R, Grace RH. Anorectal suppuration: the results of treatment and the factors influencing the recurrence rate. Br J Surg 1973;60:537–40.PubMedGoogle Scholar
  12. 12.
    Doberneck RC. Perianal suppuration: results of treatment. Am Surg 1987;53:569–72.PubMedGoogle Scholar
  13. 13.
    Sainio P. Fistula-in-ano in a defined population: incidence and epidemiological aspects. Ann Chir Gynaecol 1984;73:219–24.PubMedGoogle Scholar
  14. 14.
    Henrichsen S, Christiansen J. Incidence of fistula-in-ano complicating anorectal sepsis: a prospective study. Br J Surg 1986;73:371–2.PubMedGoogle Scholar
  15. 15.
    Ramanujam PS, Prasad ML, Abcarian H, Tan AB. Perianal abscesses and fistulas: a study of 1,023 patients. Dis Colon Rectum 1984;27:593–7.PubMedGoogle Scholar
  16. 16.
    Lai CK, Wong J, Ong GB. Anorectal suppuration: a review of 606 patients. Southeast Asian J Surg 1983;6:22–6.Google Scholar
  17. 17.
    Chrabot CM, Prasad ML, Abcarian H. Recurrent anorectal abscesses. Dis Colon Rectum 1983;26:105–8.PubMedGoogle Scholar
  18. 18.
    Fucini C. One stage treatment of anal abscesses and fistulas: a clinical appraisal on the basis of two different classifications. Int J Colorectal Dis 1991;6:12–6.CrossRefPubMedGoogle Scholar
  19. 19.
    McElwain JW, MacLean MD, Alexander RM, Hoexter B, Guthrie JF. Symposium: Anorectal problems. Experience with primary fistulectomy for anorectal abscess, a report of 1,000 cases. Dis Colon Rectum 1975;18:646–9.PubMedGoogle Scholar
  20. 20.
    Hanley PH. Rubber band seton in the management of abscess-anal fistula. Ann Surg 1978;187:435–7.PubMedGoogle Scholar
  21. 21.
    Sainio P, Husa A. Fistula-in-ano: clinical features and long-term results of surgery in 199 adults. Acta Chir Scand 1985;151:169–76.PubMedGoogle Scholar

Copyright information

© The American Society of Colon and Rectal Surgeons 1998

Authors and Affiliations

  • Kari-Pekka J. Hämäläinen
    • 1
  • A. Peter Sainio
    • 1
  1. 1.From the Fourth Department of SurgeryHelsinki University Central HospitalHelsinkiFinland

Personalised recommendations