Recurrence and incidence of fistula after urgent drainage of an anal abscess. Long-term results

• Published in: Cirugia española (English ed.) 2022-01, Vol.100 (1), p.25-32
• Main Authors: Chaveli Díaz, Carlos, Esquiroz Lizaur, Irene, Eguaras Córdoba, Inés, González Álvarez, Gregorio, Calvo Benito, Ana, Oteiza Martínez, Fabiola, de Miguel Velasco, Mario, Ciga Lozano, Miguel Ángel
• Format: Article
• Language: English
• Subjects: Absceso anal; Abscess - epidemiology; Anal abscess; Anal fistula; Drainage; Drenaje; Fístula; Humans; Incidence; Largo plazo; Long-term; Prospective Studies; Recidiva; Rectal Fistula - epidemiology; Rectal Fistula - surgery; Recurrence
• ISSN: 2173-5077; 2173-5077
• DOI: 10.1016/j.cireng.2021.11.012

[Display omitted] Anal abscess is the most frequent urgent proctological problem. The recurrence rate and reported incidence of fistula after drainage and debridement of an anal abscess is widely variable. The objective of this study is to analyse the long-term recurrence rate and the incidence of fistula after drainage and urgent debridement of an anal abscess. Retrospective observational study of a prospective cohort with anal abscess of cryptoglandular origin. All patients (n = 303) were evaluated two months and one year after the intervention. At the 5th year, all the medical records were reviewed and a telephone call or appointment was made for an assessment if necessary. Specific antecedents of anal pathology, abscess characteristics, time and type of recurrence, presence of symptoms in the first revision and presence of clinical and/or ultrasound fistula were recorded. Mean follow-up 119.7 months. Recurrence rate 48.2% (82.2% in the first year). Two hundred twenty-two ultrasounds performed. Incidence of ultrasound fistula: 70% symptomatic vs. 2.4% asymptomatic (p < 0.001). Global incidence of fistula 40.3%. The history of anal pathology and the presence of symptoms in the postoperative review significantly increase the possibility of recurrence (p < 0.001). The fistula is statistically more frequent if the abscess recurs (p < 0.001). After drainage and debridement of an anal abscess, half of the patients relapse and 40% develop fistula especially in the first year, so longer follow-ups are not necessary. Endoanal ultrasound for the evaluation of the presence of fistula is highly questionable in the absence of signs or symptoms. El absceso anal es el problema proctológico urgente más frecuente. La tasa de recidiva y la incidencia de fístula publicada tras el drenaje y desbridamiento de un absceso anal es ampliamente variable. El presente estudio tiene como objetivo analizar la tasa de recurrencia y la incidencia de fístula a largo plazo tras el drenaje y desbridamiento urgente de un absceso anal. Estudio observacional retrospectivo de una cohorte prospectiva con absceso anal de origen criptoglandular. Todos los pacientes (n = 303) fueron evaluados a los dos meses y al año de la intervención. Al quinto año se revisaron todas las historias clínicas y se llamó telefónicamente o se citó en consulta para valoración. Se registraron los antecedentes específicos de patología anal, características del absceso, momento y tipo de la recidiva, presencia de sinto