Packing Of Perianal Abscess Cavity; Does It Offer Any Advantage? A Prospective Clinical Study
European Journal of Molecular & Clinical Medicine,
2023, Volume 10, Issue 1, Pages 5179-5185
AbstractPurpose: Traditionally packing of Abscess Cavity was a sine qua non of perianal abscesses treatment. Recently the practice has been challenged, with many randomised control trials demonstrating a potentially deleterious affect on patient satisfaction and with no obvious advantages, besides putting a significant burden on healthcare resources. This study was designed to purport the fact that Perianal Abscess can be managed sufficiently fairly by incision and drainage alone.
Methods: The patients were divided into two groups after incision drainage of anorectal abscess, non-packing and packing group. Out of 160 Patients, 48 in Packing Group (PG) and 55 in Non-Packing Group (NPG) were included in the final results. Wound healing, pain during Pack removal and reinsertion, patient satisfaction towards surgery, recurrences and formation of fistulas were studied amongst two groups. The primary aim was to study the healing of wound; recurrence, fistula formation and patient satisfaction as secondary factors. Patients with chronic perianal fistulas (Crohn’s, malignancy, immunosuppressed), recurrent or horseshoe abscess were excluded from the study, as were the patients not consenting to be the part of study.
Results: Males predominated the study 81(78%), 12(11%) patients were diabetic and 52(50%) smokers. The baseline parameters such as Hb, TLC, and PLT also did not show any significant difference, the mean Hb in PG Vs NPG was 9.54±1.3 vs 9.85±1.3, mean age of presentation varied 41.5 years in NPG Vs 43 years in PG, all other baseline characteristics were similarly distributed between two groups as were the risk factors such as smoking and diabetes. Time to complete healing was only 28 days (14-120) in NPG Vs 33 days(20-180) in PG, which was however was not statistically significant. There was no significant difference between the groups regarding development of fistula (p=0.78), rates of abscess recurrence (p=0.57). Patient satisfaction scores at two and six weeks in NPG were significantly higher than PG, P<0.001, however at six months these were almost similar in both groups. Dressing changes were very painful in 64% patients in PG as Opposed to only 3% in NPG, P<0.001). The patients in NPG were pretty satisfied with their surgery except for frequent changes in pads due to soiling particularly during the first week. The satisfaction scores again dropped if the wound didn’t heal or fistula formation was considered by treating doctors.
Conclusion: Our study demonstrates that perianal abscess patient can be managed without packing. Packing is not only painful, but offers no significant advantage over non packing.
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