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Packing versus mushroom catheters following incision and drainage in anorectal abscess

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.

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References

  1. Nelson R (2002) Anorectal abscess fistula: what do we know? Surg Clin N Am 82(6):1139–1151

    Article  Google Scholar 

  2. Adamo K, Sandblom G, Brännström F, Strigård K (2016) Prevalence and recurrence rate of perianal abscess- a population-based study, Sweden 1997–2009. Int J Colorectal Dis 31(3):669–673. https://doi.org/10.1007/s00384-015-2500-7

    Article  PubMed  Google Scholar 

  3. Yeung JM, Stratton R, Watts E, Pankhurst S (2008) Community nurses’ practices in managing perianal abscesses. J Wound Care 17(10):437–440

    CAS  Article  Google Scholar 

  4. Pearce L, Newton K, Smith SR, Barrow P, Smith J, Hancock L, Kirwan CC, Hill J, North West Research Collaborative (2016) Multicentre observational study of outcomes after drainage of acute perianal abscess. Br J Surg 103(8):1063–1068. https://doi.org/10.1002/bjs.10154

    CAS  Article  PubMed  Google Scholar 

  5. Tonkin DM, Murphy E, Brooke-Smith M, Hollington P, Rieger N, Hockley S, Richardson N, Wattchow DA (2004) Perianal abscess: a pilot study comparing packing with nonpacking of the abscess cavity. Dis Colon Rectum 47(9):1510–1514

    Article  Google Scholar 

  6. Smith SR, Newton K, Smith JA, Dumville JC, Iheozor-Ejiofor Z, Pearce LE, Barrow PJ, Hancock L, Hill J (2016) Internal dressings for healing perianal abscess cavities. Cochrane Database Syst Rev 8:CD011193. https://doi.org/10.1002/14651858.CD011193.pub2

    Article  Google Scholar 

  7. Malik AI, Nelson RL, Tou S (2010) Incision and drainage of perianal abscess with or without treatment of anal fistula. Cochrane Database Syst Rev 7:CD006827. https://doi.org/10.1002/14651858.CD006827.pub2

    Article  Google Scholar 

  8. Vasilevsky CA, Gordon PH (1984) The incidence of recurrent abscesses or fistula-in-ano following anorectal suppuration. Dis Colon Rectum 27(2):126–130

    CAS  Article  Google Scholar 

  9. Onaca N, Hirshberg A, Adar R (2001) Early reoperation for perirectal abscess: a preventable complication. Dis Colon Rectum 44(10):1469–1473

    CAS  Article  Google Scholar 

  10. Beck DE, Fazio VW, Lavery IC, Jagelman DG, Weakley FL (1988) Catheter drainage of ischiorectal abscesses. South Med J 81(4):444–446

    CAS  Article  Google Scholar 

  11. Akkapulu N, Dere Ö, Zaim G, Soy HE, Özmen T, Doğrul AB (2014) A retrospective analysis of 93 cases with anorectal abscess in a rural state hospital. Ulus Cerrahi Derg 31(1):5–8

    PubMed  PubMed Central  Google Scholar 

  12. Isbister WH, Kyle S (1991) The management of anorectal abscess: an inexpensive and simple alternative technique to incision and “deroofing”. Ann Saudi Med 11(4):385–390 De Pezzer drainage

    CAS  Article  Google Scholar 

  13. Isbister WH (1987) Oct) A simple method for the management of anorectal abscess. Aust N Z J Surg. 57(10):771–774

    CAS  Article  Google Scholar 

  14. Kyle S, Isbister WH (1990) Management of anorectal abscesses: comparison between traditional incision and packing and de Pezzer catheter drainage. Aust N Z J Surg 60(2):129–131

    CAS  Article  Google Scholar 

  15. Alder AC, Thornton J, McHard K, Buckins L, Barber R, Skinner MA (2011) A comparison of traditional incision and drainage versus catheter drainage of soft tissue abscesses in children. J Pediatr Surg 46(10):1942–1947

    Article  Google Scholar 

  16. Pritchard TJ, Schoetz DJ Jr, Roberts PL, Murray JJ, Coller JA (1990) Veidenheimer MC. Perirectal abscess in Crohn’s disease. Drainage and outcome. Dis Colon Rectum 33(11):933–937

    CAS  Article  Google Scholar 

  17. Hasan RM (2016) A study assessing postoperative corrugate rubber drain of perianal abscess. Ann Med Surg (Lond) 11:42–46 eCollection 2016

    Article  Google Scholar 

  18. Pang LM, Kong FB, Wang XT, Li DG, Li YB, Sun PL, Huang HY, Liu CQ, Wei M (2015) Efficacy of vacuum sealing drainage after incision of perianal abscess: preliminary experience. Am Surg 81(11):E379–E382

    PubMed  Google Scholar 

  19. The EuroQol Group (1990) EuroQol-a new facility for the measurement of health-related quality of life. Health Policy 16(3):199–208

    Article  Google Scholar 

  20. Perera AP, Howell AM, Sodergren MH, Farne H, Darzi A, Purkayastha S, Paraskeva P (2015) A pilot randomised controlled trial evaluating postoperative packing of the perianal abscess. Langenbeck's Arch Surg 400(2):267–271. https://doi.org/10.1007/s00423-014-1231-5

    CAS  Article  Google Scholar 

  21. Leinwand M, Downing M, Slater D, Beck M, Burton K, Moyer D (2013) Incision and drainage of subcutaneous abscesses without the use of packing. J Pediatr Surg 48(9):1962–1965. https://doi.org/10.1016/j.jpedsurg.2013.01.027

    Article  PubMed  Google Scholar 

  22. Naeem M, Rahimnajjad MK, Rahimnajjad NA, Ahmed QJ, Fazel PA, Owais M (2012) Comparison of incision and drainage against needle aspiration for the treatment of breastabscess. Am Surg 78(11):1224–1227

    PubMed  Google Scholar 

  23. Makowiec F, Jehle EC, Becker HD, Starlinger M (1997) Perianal abscess in Crohn’s disease. Dis Colon Rectum 40(4):443–450

    CAS  Article  Google Scholar 

  24. Baker J, Windsor J (2007) Management of adult superficial acute abscesses in a tertiary hospital: time for incisive action. N Z Med J 122(1295):37–46

    Google Scholar 

  25. Sözener U, Gedik E, Kessaf Aslar A, Ergun H, Halil Elhan A, Memikoğlu O, Bulent Erkek A, Ayhan Kuzu M (2011) Does adjuvant antibiotic treatment after drainage of anorectal abscess prevent development of anal fistulas? A randomized, placebo-controlled, double-blind, multicenter study. Dis Colon Rectum 54(8):923–929. https://doi.org/10.1097/DCR.0b013e31821cc1f9

    Article  PubMed  Google Scholar 

  26. Millan M, García-Granero E, Esclápez P, Flor-Lorente B, Espí A, Lledó S (2006) Management of intersphincteric abscesses. Color Dis 8(9):777–780

    CAS  Article  Google Scholar 

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Correspondence to Helen M. Mohan.

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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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Zhu, D.A., Houlihan, L.M., Mohan, H.M. et al. Packing versus mushroom catheters following incision and drainage in anorectal abscess. Ir J Med Sci 188, 1343–1348 (2019). https://doi.org/10.1007/s11845-018-01958-6

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  • DOI: https://doi.org/10.1007/s11845-018-01958-6

Keywords

  • Anorectal abscess
  • Incision and drainage
  • Mushroom catheter
  • Packing
  • Perianal abscess