How can I prevent a fistula from coming back after treatment?

Trials that treated the fistula tract (with a seton or fistulotomy) at the same time as drainage had much lower recurrence than drainage alone. There's no trial testing a way to prevent recurrence after a fistula has already been separately treated and healed.

Should I ask for antibiotics after my abscess is drained to prevent a fistula?

The trial evidence is mixed. One randomised trial found fewer fistulas with antibiotics, another randomised trial found more fistulas with antibiotics, and a pooled analysis of six studies called the overall evidence low quality. Antibiotics are not a reliable way to prevent a fistula on current evidence.

Does packing the wound after drainage help prevent a fistula?

No. A randomised trial and a separate pooled analysis both found no difference in fistula or abscess recurrence between packed and unpacked wounds, and packing caused more pain.

Is treating the fistula at the same time as the abscess risky for bowel control?

In the main pooled trial review, adding fistula treatment to drainage did not significantly increase incontinence, but the patients studied were carefully selected as suitable for it. More extensive fistula surgery in other studies has been linked to higher incontinence risk, so this is a decision to make with a surgeon based on your specific anatomy.

How can you prevent an anal fistula from forming?

Name: How can you prevent an anal fistula from forming?
Published: 2026-10-31
Keywords: how to prevent fistula, how to prevent anal fistula, how to avoid fistula, how to prevent a fistula from forming, how to prevent fistula in ano, how to prevent fistula recurrence, how to prevent fistula after abscess, how to prevent fistula from coming back

In patients with an anorectal (perianal) abscess, what treatments or practices at the time of abscess drainage reduce the subsequent risk of developing anal fistula (fistula-in-ano) or having it recur?

How people search for this, in their own words

“how to prevent fistula”
“how to prevent anal fistula”
“how to avoid fistula”
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“how to prevent fistula in ano”
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“how to prevent fistula after abscess”
“how to prevent fistula from coming back”

Evidence review in plain language · compiled 2026-10-31 · checked 2026-10-31 · next 2026-12-01 · automated review, how it works

Bottom line

In trials of people having an abscess drained, treating the fistula tract at the same time (with a seton or fistulotomy) lowered the chance of a fistula forming or needing repeat surgery, compared with draining the abscess alone.

This comes from randomised trials that compared drainage alone with drainage plus a fistula-tract procedure, in patients who were selected as suitable candidates for the combined approach. Trials on whether antibiotics after drainage prevent a fistula disagree with each other, and trials on wound packing found no benefit for preventing a fistula — only more pain.

How well studied

Well studied

5 well-conducted randomised trials address this question directly.

This question weighs several approaches rather than testing one treatment, so there is no single works-or-doesn't verdict. What can be shown is how well it has been studied.

answer it directly: 23answer it directly
studies found: 89studies found
randomised trials: 7randomised trials
people studied: 17,383people studied
reviews of trials: 8reviews of trials
years covered: 1976–2026years covered

What the research shows

Incidence of fistula-in-ano formation after abscess drainage
Randomised trials that added a fistula-tract procedure (seton or fistulotomy) to drainage found fewer fistulas than drainage alone. Trials on antibiotics disagree: one found fewer fistulas with antibiotics, another found more, and a pooled analysis called the evidence low quality. Whether the wound was packed or left open made no difference.[1,2,3,4,5,6,7,8]
Some evidence
Fistula recurrence rate
The pooled review of trials and a seton trial found that treating the fistula tract at the same time as drainage lowered recurrence substantially compared with drainage alone.[1,2,3]
Found in studies
Abscess recurrence rate
The same combined procedure lowered abscess/fistula recurrence and the need for repeat surgery in the pooled trial review. A separate trial comparing wound packing with no packing found no difference in abscess recurrence between the two.[1,2]
Some evidence
Need for repeat surgery
Treating the fistula at the time of drainage greatly lowered the chance of needing another operation, compared with drainage alone, across six pooled trials.[1]
Found in studies
Wound healing time
A trial found that leaving the wound unpacked caused less pain than packing, with no clear downside; a separate pooled analysis found packing made no difference to later fistula formation.[1,2]
Some evidence
Fecal incontinence or other complication rates
The pooled trial review found no statistically significant increase in incontinence when fistula treatment was added to drainage, but the patients studied were described as 'carefully selected.' Other studies note incontinence risk rises with more extensive fistula surgery, so the risk for an unselected patient isn't well defined.[1,2,3]
Too little evidence

What the studies found

Randomised trials that treated the fistula tract (with a seton, fistulotomy, or similar procedure) at the same time as draining the abscess found lower rates of recurrence and less need for repeat surgery than drainage alone.[1,2,3]
A randomised trial found that leaving the drainage wound unpacked, instead of traditionally packing it, caused less pain, with similarly low rates of later fistula or abscess recurrence in both groups.[1]

Important limitations

The studies identifying these risk factors, including this one, are retrospective reviews of medical records rather than randomized trials, so patients who received one treatment may have differed from patients who received another in ways that affected their risk, not just the treatment itself.[1,2,3,4]
The main trial evidence for combining fistula treatment with drainage comes from a pooled review of just six trials totalling 479 people, and the effect on incontinence was too imprecise to draw firm conclusions (95% confidence interval 0.7 to 13.45) — so results may not apply to everyone having an abscess drained.[1]
Randomised trials on antibiotics directly disagree: one found fewer fistulas with antibiotics, another found more, and a pooled analysis of six studies rated the overall evidence quality low.[1,2,3]

What kind of studies

Retrospective51 · 57%
Case series7 · 8%
Randomised trial7 · 8%
Narrative review6 · 7%
Prospective cohort6 · 7%
Meta-analysis5 · 6%
Guideline4 · 4%
Systematic review3 · 3%

The key studies

Zhang et al. 2025
A randomized controlled trial of trans-intersphincteric double seton (TRISDS) for the treatment of perianal abscess
Double seton cut fistula risk more.Randomised trialModerate quality
106 people12 months
TRISDS led to a much higher cure (no-fistula) rate than plain incision and drainage, with similar anal muscle function afterward
Who was studied
adults with perianal abscesses located below the levator ani muscle with an internal opening
What they received
trans-intersphincteric double seton technique (TRISDS) with two loose setons placed at time of drainage
Compared with
conventional incision and drainage (I&D) without seton
Main outcome
cure rate: complete wound healing with no fistula, no drainage, and no recurrence within 12 months
Quality
it was a randomized trial with a clear outcome, but it was not blinded and appears to be from a single center, so the result needs confirming elsewhere.
Limitations
non-blinded, single study; abstract does not state number of centers or report loss to follow-up
Taken word for word from the abstract
- n TRISDS group (n = 55) or the I&D group (n = 51)
- population adult patients with perianal abscesses located below the levator ani muscle with an internal opening
- intervention trans-intersphincteric double seton (TRISDS), designed to preserve anal sphincter integrity
- comparator The I&D group underwent conventional I&D without damaging the anal sphincter complex.
- primaryOutcome The primary outcome was the cure rate of perianal abscesses, which was defined as complete epithelialization of wounds without fistula or exudate and no recurrence within 12 months after surgery.
- result The TRISDS group achieved a significantly higher cure rate of 78.2% (43/55) compared to 41.2% (21/51) in the I&D group (P < 0.05).
Gastroenterol Rep (Oxf) · PMID 41035902 · Read it on PubMed ↗
Newton et al. 2022
Postoperative Packing of Perianal Abscess Cavities (PPAC2): randomized clinical trial
No difference in fistula ratesRandomised trialModerate quality
433 people6 months
not packing the wound caused less pain than packing, and fistula and abscess recurrence rates were similarly low in both groups with no statistically significant difference
Who was studied
adults having surgery to drain a perianal abscess
What they received
leaving the wound cavity unpacked after drainage
Compared with
traditional internal wound packing after drainage
Main outcome
pain level after surgery, and rates of fistula or abscess recurrence
Quality
this was a reasonably large multicentre randomized trial with blinded outcome assessment, but it was not specifically designed or powered to detect a difference in fistula formation, which was a secondary outcome with wide confidence intervals.
Limitations
the trial's primary aim was pain, not fistula prevention; the comparison of fistula/abscess rates had wide confidence intervals and did not reach statistical significance
Taken word for word from the abstract
- population adult participants admitted to an NHS hospital for incision and drainage of a primary perianal abscess
- intervention non-packing
- comparator continued postoperative wound packing
- primaryOutcome The primary outcome was pain (mean maximum pain score on a 100-point visual analogue scale).
- n 433 participants (mean age 42 years) were randomized across 50 sites
- result The occurrence of fistula-in-ano was low in both groups: 32/213 (15 per cent) in the packing group and 24/220 (11 per cent) in the non-packing group (OR 0.69, 95 per cent c.i. 0.39 to 1.22; P = 0.20).
Br J Surg · PMID 35929816 · Read it on PubMed ↗
Shi et al. 2021
A systematic review and meta-analysis of incision and seton drainage in the treatment of high perianal abscess
Seton placement lowered fistula formationMeta-analysisModerate quality
size not given2021
six of the included studies found the rate of fistula formation was lower with incision-seton drainage than with incision-drainage alone
Who was studied
people with high perianal abscess
What they received
incision and seton drainage
Compared with
incision and drainage alone
Main outcome
rate of anal fistula forming after treatment
Quality
it pools several randomized trials, which is strong in principle, but the trials were evaluated for risk of bias and the authors themselves say there are still gaps in the evidence and call for more large, high-quality trials.
Limitations
the authors state the meta-analysis still leaves some gaps in the evidence and call for more large-sample, high-quality, multi-center RCTs
Taken word for word from the abstract
- population treatment of high perianal abscess
- intervention incision and seton drainage
- comparator incision-drainage group
- primaryOutcome the formation rate of anal fistula in the incision-seton group was lower than that in the incision-drainage group
- result Six studies showed that the formation rate of anal fistula in the incision-seton group was lower than that in the incision-drainage group (P<0.05).
- n Fourteen RCTs were included.
Ann Palliat Med · PMID 34628909 · Read it on PubMed ↗
Mocanu et al. 2019
Antibiotic use in prevention of anal fistulas following incision and drainage of anorectal abscesses: A systematic review and meta-analysis
Antibiotics lowered fistula risk.Meta-analysisLow quality
817 peopleone to 30 months
Antibiotics were linked to fewer fistulas (16% vs 24%), a statistically significant 36% lower odds of fistula formation
Who was studied
Adults with anorectal abscess treated with incision and drainage
What they received
Postoperative antibiotics after drainage
Compared with
No postoperative antibiotics after drainage
Main outcome
Development of anal fistula after abscess drainage
Quality
The authors themselves say the evidence quality is low, based on only six studies with varying methods and only three contributing to the pooled statistic.
Limitations
Only six studies included, antibiotic regimens varied between studies, and the authors state quality of evidence is low; further randomized trials are called for.
Taken word for word from the abstract
- population following incision and drainage of anorectal abscesses
- intervention Postoperative antibiotics have been used to account for these limitations
- comparator 358 (43.8%) underwent management without antibiotics
- primaryOutcome determine the role of antibiotics in prevention of anal fistula following incision and drainage of anorectal abscesses
- result Fistula rate in subjects receiving antibiotics was 16% versus 24% in those not receiving postoperative antibiotics. Meta-analysis revealed a statistically significant protective effect for antibiotic treatment (3 studies, OR 0.64; CI 0.43-0.96; P = 0.03).
- n A total of six studies with 817 patients were included for systematic review.
- followUp the follow up ranged from one to 30 months
- qualityWhy although quality of evidence is low
Am J Surg · PMID 30773213 · Read it on PubMed ↗
Ghahramani et al. 2017
Antibiotic therapy for prevention of fistula in-ano after incision and drainage of simple perianal abscess: A randomized single blind clinical trial
Antibiotics after drainage lowered fistula risk.Randomised trialModerate quality
299 people3 months
patients given antibiotics after surgery had a lower rate of fistula formation than those who received no antibiotics
Who was studied
patients referring for incision and drainage of perianal abscess at Shahid Faghihi Hospital, Shiraz, Iran
What they received
7 days of antibiotics (metronidazole and ciprofloxacin) after surgery plus standard care
Compared with
standard care alone, no antibiotics after surgery
Main outcome
whether a fistula formed within 3 months after surgery
Quality
it was a randomized trial with a reasonably large number of patients, but it was only single-blind and conducted at one hospital, which limits confidence.
Limitations
single-blind design, single center, short follow-up of only 3 months, 7 patients lost to follow-up
Taken word for word from the abstract
- population 307 patients were randomly selected from those referring for incision and drainage of perianal abscess at Shahid Faghihi Hospital, Shiraz, Iran, during September 2013 to September 2014
- intervention Patients were allocated randomly either to receive 7 days of oral metronidazole and ciprofloxacin in addition to their standard care
- comparator or to only receive standard care without any antibiotics after they were discharged from the hospital
- primaryOutcome We evaluated the role of postoperative antibiotics in the prevention of fistula in-ano after incision and drainage of perianal abscess.
- result Those who used prophylactic antibiotics (n = 155) had significantly lower rates of fistula formation compared with those who did not use any medication (n = 144; P < .001).
- n 307 patients were randomly selected
- n Seven patients were lost to follow-up.
Surgery · PMID 28822559 · Read it on PubMed ↗
Sözener et al. 2011
Does adjuvant antibiotic treatment after drainage of anorectal abscess prevent development of anal fistulas? A randomized, placebo-controlled, double-blind, multicenter study
Antibiotics did not prevent fistulas; rate was higherRandomised trialModerate quality
151 people1-year follow-up
fistulas formed in 37.3% of the antibiotic group versus 22.4% of the placebo group, a higher rate with antibiotics
Who was studied
adults with an anorectal abscess after incision and drainage
What they received
antibiotic treatment (amoxicillin-clavulanic acid) for 10 days after drainage
Compared with
placebo after drainage
Main outcome
development of an anal fistula within 1 year
Quality
it was a well-designed randomized, blinded, multicenter trial, but the main analysis only included 151 of the 183 people originally randomized, which weakens confidence in the exact numbers.
Limitations
per-protocol analysis excluded some randomized patients, and the abstract does not give full details on reasons for exclusion or loss to follow-up
Taken word for word from the abstract
- population Patients who underwent abscess drainage between September 2005 and January 2008 were evaluated for eligibility.
- intervention Patients were randomly assigned to receive placebo or amoxicillin-clavulanic acid combination treatment for 10 days after abscess drainage.
- comparator Patients were randomly assigned to receive placebo or amoxicillin-clavulanic acid combination treatment for 10 days after abscess drainage.
- primaryOutcome The primary end point was rate of anorectal fistula formation at 1-year follow-up.
- result Fistula formation occurred in 17 patients (22.4%) in the placebo group and in 28 patients (37.3%) in the antibiotic group (P = .044).
- n Data were available for per-protocol analysis from 151 patients (placebo, 76; antibiotics, 75)
- followUp 1-year follow-up
Dis Colon Rectum · PMID 21730779 · Read it on PubMed ↗
Malik et al. 2010
Incision and drainage of perianal abscess with or without treatment of anal fistula
Fewer repeat abscesses with fistula surgery.Meta-analysisModerate quality
479 peopleone year
fistula surgery with abscess drainage greatly lowered the chance of the abscess or fistula recurring or needing repeat surgery, with no statistically significant increase in incontinence
Who was studied
people with a perianal abscess having incision and drainage surgery
What they received
treating the fistula (fistula surgery) at the same time as abscess drainage
Compared with
incision and drainage of the abscess alone, without fistula treatment
Main outcome
abscess or fistula coming back or needing repeat surgery, and incontinence
Quality
it pools six randomised trials but they were small, differed from each other (heterogeneity), and patients were selectively chosen for fistula treatment, so the incontinence result is uncertain.
Limitations
only six trials totalling 479 people, noticeable heterogeneity between trials for the incontinence outcome, and patients needed to be 'carefully selected' for the combined procedure
Taken word for word from the abstract
- n We identified six trials, involving 479 subjects
- population incision and drainage of perianal abscess
- intervention Treating the fistula at the same time as incision and drainage of the abscess
- comparator drainage of perianal abscess compared with drainage alone
- primaryOutcome The primary outcomes were recurrent or persistent abscess/fistula which may require repeat surgery and short-term and long-term incontinence.
- result Metaanalysis showed a significant reduction in recurrence, persistent abscess/fistula or repeat surgery in favour of fistula surgery at the time of abscess incision and drainage (RR=0.13, 95% Confidence Interval of RR = 0.07-0.24).
- result Incontinence at one year following drainage with fistula surgery was not statistically significant (pooled RR 3.06, 95% Confidence Interval 0.7-13.45)
Cochrane Database Syst Rev · PMID 20614450 · Read it on PubMed ↗

What actually helps, on this site

More about the condition:

All 89 studiesEvery study that answered the question, with its design, size and result.

The other 82 studiesEverything else the search returned, including anything retracted.

Akay et al. 2026
Comparison of incision and drainage procedure with drainage and ligation of the intersphincteric fistula tract in the treatment of deep perianal abscess
Added LIFT reduced persistent fistulaRetrospectiveLow quality
111 people6 months
Adding LIFT at the time of drainage greatly lowered the rate of persistent fistula compared with drainage alone (5.7% vs 38.2% at 6 months), and statistical modeling supported a strong reduction in fistula persistence with LIFT
Who was studied
Adults with deep perianal abscess and transsphincteric fistula requiring emergency incision and drainage
What they received
Incision and drainage combined with ligation of the intersphincteric fistula tract (LIFT) at the same time
Compared with
Incision and drainage alone
Main outcome
Whether the fistula was still present (persistent) at 6 months, checked by exam and MRI
Quality
It is a retrospective, non-randomized comparison from one institution, so differences between groups other than treatment could explain the results, and the authors themselves say this needs confirmation by randomized trials.
Limitations
Non-randomized, retrospective design; authors state findings should be interpreted with caution and need confirmation through prospective randomized controlled trials; some patients lost between 3- and 6-month follow-up (55 and 53 remaining instead of 57 and 54).
Taken word for word from the abstract
- population Patients with deep perianal abscess (DPA) and transsphincteric fistula typically require incision and drainage as emergency treatment.
- intervention Group II (incision and drainage combined with the LIFT procedure, n = 54)
- comparator Group I (incision and drainage alone, n = 57)
- primaryOutcome The primary endpoint was persistent fistula at 6 months, confirmed by clinical examination and magnetic resonance imaging (MRI).
- result At the 6th month, persistent fistula was observed in 21 of 55 patients (38.2%) in Group I and 3 of 53 patients (5.7%) in Group II (P < 0.001).
- n includes 111 patients divided into two groups
- design This study is a retrospective analysis of an institutional protocol
Sci Rep · PMID 42321429 · Read it on PubMed ↗
Yuan et al. 2026
Age-stratified management of pediatric perianal abscesses: a proposed framework integrating the "Developmental Healing Axis"
Drainage may raise fistula risk in older kids; antibiotics often enough in infantsNarrative reviewLow quality
size not given2026
Surgical incision and drainage relieves symptoms quickly but may raise fistula risk, especially in older children, while antibiotics and watchful waiting often work well in infants and young children due to their better healing ability
Who was studied
Children with perianal abscesses, with differences noted between infants/young children and older children
Main outcome
Preventing fistula formation and recurrence after abscess management
Quality
This is a narrative review that summarizes existing studies and opinions rather than testing treatments directly, so it cannot prove which approach actually prevents fistulas.
Limitations
Narrative (non-systematic) review; authors note gaps in evidence and lack of standardized treatment protocols; no original comparative data or statistics given.
Taken word for word from the abstract
- population Pediatric perianal abscesses represent a frequent yet underrecognized condition
- primaryOutcome minimize recurrence, and prevent fistula development
- result Surgical interventions such as incision and drainage offer rapid symptom relief but may increase the risk of fistula formation, particularly in older children. In contrast, conservative strategies including antibiotic therapy and observation are often effective in infants and young children, reflecting their superior regenerative capacity.
Front Pediatr · PMID 42221001 · Read it on PubMed ↗
Zhang et al. 2026
Ascending complex anal fistula secondary to lower extremity soft tissue infection: a case report
Not about preventing fistulas.Case seriesVery low qualityRelated question
1 peoplesix-month follow-up
This case report describes treatment of an already-formed complex fistula, not a method to prevent fistula formation
Who was studied
57-year-old man with a complex anal fistula extending from the buttock to the thigh, following a prior lower leg soft tissue infection
Main outcome
Wound healing and anal sphincter function after surgery
Quality
A single case report cannot show whether any approach prevents fistulas from forming, since it only describes treating one that already existed.
Limitations
Single patient; fistula was already fully formed and complex before treatment; no comparison of prevention strategies at time of abscess drainage.
Taken word for word from the abstract
- population A 57-year-old man presented with recurrent purulent discharge from the perianal region and left lower limb for three months following debridement of a lower extremity soft tissue infection.
- n A 57-year-old man presented
- result The patient underwent fistulotomy with drainage tube placement for the high trans-sphincteric tract extending to the supralevator space, along with partial sinus tract excision and drainage tube insertion.
- primaryOutcome at six-month follow-up, the wounds had completely healed with no signs of recurrence and normal anal sphincter function
Front Surg · PMID 42147392 · Read it on PubMed ↗
Xuan et al. 2026
Three-cavity clearance significantly reduces the postoperative fistula rate and abscess recurrence following glandular perianal abscess: a single-center real-world study
Low fistula rate after this surgeryRetrospectiveLow qualityRelated question
308 people37.9 ± 16.8 months
after TCC, 4.9% developed a fistula and 8.1% had the abscess come back, with an overall treatment success rate of 87.0%
Who was studied
adults with perianal abscess caused by gland infection who had surgery
What they received
a surgical technique called three-cavity clearance (TCC) used to treat the abscess
Main outcome
rate of fistula developing after surgery and abscess coming back
Quality
this was a single-center look-back study of one surgical technique with no comparison group, so it can't show whether TCC works better than other ways of treating the abscess.
Limitations
retrospective design, single center, and no comparator group to show whether TCC is better than standard incision and drainage or other preventive approaches
Taken word for word from the abstract
- population patients who underwent TCC at the Second Affiliated Hospital of Nanjing University of Chinese Medicine from January 2018 to January 2024
- intervention three-cavity clearance (TCC) in the treatment of glandular perianal abscesses
- primaryOutcome explore the risk factors for postoperative anal fistula and perianal abscess recurrence
- result The postoperative fistula rate was 4.9%, and the abscess recurrence rate was 8.1%.
- result The total success rate was 87.0%.
- n A total of 308 patients were included from January 2018 to January 2024
- followUp with an average follow-up time of 37.9 ± 16.8 months
Tech Coloproctol · PMID 42132969 · Read it on PubMed ↗
Gujar et al. 2026
Clinical Patterns and Treatment Outcomes of Selected Benign Anorectal Conditions in a Tertiary Care Hospital in Vijayapura, India: A Retrospective Observational Study
Does not address fistula prevention after abscessRetrospectiveVery low qualityRelated question
162 people2026
Across the three separate conditions studied, symptom relief exceeded 85%, and recurrence was low after fissure surgery but comparatively higher in fistula cases; the study did not track abscess patients forward to see which developed fistula, nor did it compare preventive techniques like primary fistulotomy, seton placement, antibiotics, or packing at the time of abscess drainage
Who was studied
Adult patients with anal fissure, fistula-in-ano, or anorectal abscess treated at a tertiary care hospital
Main outcome
Symptom resolution, wound healing, complications, and recurrence after standard treatment
Quality
This is a retrospective record review that treats fistula-in-ano and anorectal abscess as separate diagnostic groups rather than following abscess patients to see who develops a fistula, so it cannot tell us whether any drainage-time technique prevents fistula formation.
Limitations
Retrospective, single-centre design; no comparison of prevention strategies (fistulotomy, seton, antibiotics, packing) at time of abscess drainage; abscess and fistula patients appear to be separate cohorts rather than a followed group.
Taken word for word from the abstract
- population Adult patients aged 18 years and above with a documented diagnosis of anal fissure, fistula-in-ano, or anorectal abscess were included.
- n A total of 162 patients were included.
- primaryOutcome Outcome measures included symptom resolution, wound healing, postoperative complications, and recurrence.
- result Overall, symptom relief exceeded 85% across groups. Recurrence was low after fissure surgery and comparatively higher in fistula cases.
Cureus · PMID 42005132 · Read it on PubMed ↗
Borkowski et al. 2026
Predictors of Recurrence in Pediatric Perianal Abscess and Fistula-In-Ano: Insights From a 5-Year Surgical Cohort Study
No prevention method tested; antibiotics didn't help.RetrospectiveLow qualityRelated question
108 people2026
Antibiotic therapy, abscess size, and symptom duration were not linked to recurrence; having a fistula found at the first operation predicted higher recurrence, especially of fistula
Who was studied
children aged 0-17 years treated surgically for perianal abscess and/or fistula-in-ano
Main outcome
recurrence of perianal abscess or fistula-in-ano after surgery
Quality
This is a retrospective single-center chart review without a control group or randomization, so it can show associations but not prove what prevents fistula formation.
Limitations
Retrospective design, single center, no comparison between different prevention strategies (such as primary fistulotomy or seton placement), many ultrasound results were inconclusive.
Taken word for word from the abstract
- population We retrospectively reviewed 108 pediatric patients (0-17 years) treated surgically for PA and/or FIA between January 2019 and February 2024 at a tertiary care center.
- n We retrospectively reviewed 108 pediatric patients (0-17 years) treated surgically for PA and/or FIA
- primaryOutcome This study aimed to evaluate recurrence rates after surgical treatment of PA and FIA and identify clinical factors associated with fistula formation
- result Antibiotic therapy, abscess size, and symptom duration showed no significant association with recurrence or FIA development.
- result FIA recurrence was significantly higher in patients with initial FIA (31.6% vs 10.1%, P=0.024).
Med Sci Monit · PMID 41578630 · Read it on PubMed ↗
Mersal et al. 2026
Beyond the Knife: A Contemporary Review of Subcutaneous Abscesses
Antibiotics' fistula benefit unclear; packing not helpfulNarrative reviewLow quality
size not given2026
For perianal abscesses, trials on antibiotics to prevent fistula-in-ano conflict, with pooled estimates suggesting only a modest benefit; routine wound packing shows no outcome advantage and increases pain, so simple dressings or selective drains are now favored.
Who was studied
Adults and children with perianal or cutaneous abscesses after incision and drainage
Main outcome
Preventing fistula-in-ano after abscess drainage
Quality
This is a narrative review summarizing other trials rather than a new study, without a described systematic search or pooling method, so its conclusions carry less weight than a primary trial or meta-analysis.
Limitations
Review acknowledges that trial evidence on antibiotics for preventing fistula-in-ano is conflicting and relies on pooled estimates rather than a single definitive trial.
Taken word for word from the abstract
- population to perianal abscesses, where the risk of developing a fistula-in-ano is substantial
- primaryOutcome the goal shifts to preventing fistula-in-ano
- result For perianal abscesses, the goal shifts to preventing fistula-in-ano: here the trials conflict, pooled estimates hint at a modest benefit from antibiotics, and clinical judgment still matters.
- result Perhaps the clearest evidence-based shift is against routine packing, as it offers no outcome advantage and clearly increases pain.
ANZ J Surg · PMID 41420370 · Read it on PubMed ↗
Alam et al. 2025
Does antibiotic therapy for anal abscess reduce the risk of fistula surgery? A retrospective study
Antibiotics after incision lowered recurrence.RetrospectiveLow quality
109 peopleapproximately 30 months
absence of antibiotic therapy after incision was linked to higher recurrence; giving antibiotics was associated with lower recurrence risk
Who was studied
adults with a first-time perianal abscess treated by incision
What they received
antibiotic therapy given after incision
Compared with
no antibiotic therapy after incision
Main outcome
rate of patients needing fistula surgery and/or having abscess recurrence
Quality
This is a retrospective study with only univariate analysis (multivariate not possible due to insufficient data), so the antibiotic link could be confounded by other factors.
Limitations
Retrospective design, single center, multivariate analysis could not be performed due to insufficient data, and authors call for randomized trials to confirm findings.
Taken word for word from the abstract
- population patients presenting in 2019 with a first perianal abscess treated by incision under local anesthesia
- intervention antibiotic therapy post-incision
- comparator absence of antibiotic therapy post-incision
- primaryOutcome The primary outcome was the rate of patients requiring fistula surgery and/or experiencing abscess recurrence
- result smoking and absence of antibiotic therapy post-incision as predictive of recurrence with (OR 0.44) were predictive of recurrence
- result the administration of antibiotic therapy post-incision was associated with a reduced likelihood of recurrence
- n Among 109 patients (mean age 43 ± 13 years; 74 % male)
- followUp The mean follow-up for patients with incision alone was approximately 30 months
Clin Res Hepatol Gastroenterol · PMID 41047078 · Read it on PubMed ↗
Fang et al. 2025
Multifactorial Analysis of Postoperative Recurrence of Anal Fistula: A Retrospective Study
Better wound care, imaging lowered fistula riskRetrospectiveLow qualityRelated question
435 peoplemedian follow-up period of 25 months (range 18-40 months)
A history of abscess, enteritis, Parks classification, and leftover pus pockets during surgery were linked to higher fistula risk, while standardized dressing changes after discharge, preoperative ultrasound or MRI, and postoperative anal function (Wexner) assessment were linked to better outcomes
Who was studied
Adults with perianal abscesses who had surgery for incision and drainage
Main outcome
Formation of an anal fistula (recurrence) after perianal abscess surgery
Quality
It is a retrospective study with only 27 fistula cases out of 435 patients, so the risk-factor estimates are imprecise and cannot prove cause and effect.
Limitations
Retrospective case-control design, small number of fistula events, factors identified by statistical association rather than by testing a specific preventive technique like fistulotomy or seton placement
Taken word for word from the abstract
- population patients with perianal abscesses who underwent surgical treatment
- n A total of 435 patients were included in the study
- primaryOutcome the recurrence of anal fistulas in patients with perianal abscesses following incision and drainage treatment
- result a history of abscesses, enteritis, intraoperative pus cavity residue, standardized dressing changes after discharge, the surgeon's specialty, preoperative ultrasound or MRI examination, Parks classification and Wexner score were independently influential factors in the formation of anal fistulas after perianal abscess surgery
- followUp median follow-up period of 25 months (range 18-40 months)
J Multidiscip Healthc · PMID 41019154 · Read it on PubMed ↗
Acker et al. 2025
Management of Perianal Abscesses in Infants: A Systematic Review From the APSA Outcomes and Evidence-Based Practice Committee
Similar fistula risk regardless of approachSystematic reviewLow qualityRelated question
size not given2025
about 21% developed a fistula after non-operative management and 20% after incision and drainage; recurrence after surgical fistula repair was about 7%, and time to full resolution did not clearly differ by approach
Who was studied
infants with perianal abscess or fistula-in-ano
What they received
different management approaches for perianal abscess: non-operative care (hygiene, sitz baths, antibiotics), incision and drainage, or upfront surgical fistulotomy
Compared with
the other management approaches among the same options
Main outcome
development of fistula-in-ano and recurrence after treatment
Quality
this is a review of mostly small, low-quality (level 3-4) studies in a narrow population of infants, so it gives weak and possibly non-generalizable evidence.
Limitations
Included studies were level 3-4 evidence with heterogeneous methods; population was infants only, not the broader adult/child population asked about, and specific preventive techniques like primary fistulotomy or seton placement at time of drainage were not directly compared as preventive strategies.
Taken word for word from the abstract
- population Management of infant perianal disease, including perianal abscess and fistula-in- ano (FIA)
- intervention nonoperative management (NOM) strategies (such as hygiene, sitz baths, and systemic antibiotics), operative intervention for abscess only (incision and drainage (I&D)) or direct surgical management of the FIA (e.g. upfront fistulotomy)
- comparator operative intervention for abscess only (incision and drainage (I&D)) or direct surgical management of the FIA (e.g. upfront fistulotomy)
- primaryOutcome The rate of FIA development is approximately 21 % after NOM and 20 % after I&D.
- result Recurrence rate after initial success with NOM or I&D is approximately 21 % and 24 %, respectively. The rate of FIA development is approximately 21 % after NOM and 20 % after I&D. Recurrence after operative management of FIA, regardless of approach, is 7 %. Time to complete resolution varies widely and does not appear to differ based on treatment strategy.
J Pediatr Surg · PMID 40983150 · Read it on PubMed ↗
Chen et al. 2025
Treatment of perianal abscess and anal fistula in infants: a systematic review
No clear difference, surgery vs conservative care.Systematic reviewLow qualityRelated question
1,770 people2025
Similar cure and recurrence rates between conservative and surgical treatment
Who was studied
Infants with perianal abscess or anal fistula
What they received
Surgical treatment
Compared with
Conservative (non-surgical) treatment
Main outcome
Cure and recurrence rates of abscess or fistula
Quality
All included studies were retrospective, which makes the comparison between treatments less reliable.
Limitations
All 18 included studies were retrospective; population is infants, not the broader population of adults and children with anorectal abscess asked about.
Taken word for word from the abstract
- n A total of eighteen retrospective studies, encompassing 1,770 patients, were analyzed.
- population The optimal treatment approach for perianal abscess (PA) and fistula-in-ano (FIA) in infants remains a subject of debate.
- intervention 1,068 cases (61.3%) that received surgical interventions
- comparator 702 cases (38.7%) that underwent conservative treatment
- primaryOutcome minimal differences in the cure and recurrence rates of PA and FIA between the conservative and surgical treatment groups
- result The available studies indicate minimal differences in the cure and recurrence rates of PA and FIA between the conservative and surgical treatment groups.
Front Surg · PMID 40585484 · Read it on PubMed ↗
Van De Putte et al. 2025
Ligation of the intersphincteric fistula fract (LIFT) in complex anorectal fistulas: retrospective analysis of the outcomes in a tertiary hospital
Study treats existing fistulas, not prevention.RetrospectiveLow qualityRelated question
92 people19.3 months
71% of fistulas closed initially, rising to 89% after further procedures; smoking increased the risk of failure; prolonged oral antibiotics reduced the risk of wound dehiscence after surgery
Who was studied
adults with complex (high intersphincteric) anal fistulas undergoing a specific surgical repair, not patients with a fresh anorectal abscess at risk of fistula formation
What they received
LIFT procedure (ligation of intersphincteric fistula tract) for an already-formed fistula, with some patients also receiving prolonged oral antibiotics afterward
Main outcome
whether the fistula closed after LIFT surgery
Quality
this is a single-center retrospective review of patients who already had fistulas and were treated with one surgery, with no comparison group, so it cannot speak to preventing fistula formation after abscess drainage.
Limitations
Retrospective design, no control group, single tertiary center, and the population already had established complex fistulas rather than being abscess patients at risk of developing one.
Taken word for word from the abstract
- population high intersphincteric anorectal fistulas
- n Ninety-two patients were included in the study
- intervention Ligation of Intersphincteric Fistula Tract (LIFT) procedure
- primaryOutcome The primary endpoint was the success rate of fistula closure, confirmed with clinical investigation.
- result fistula closure was achieved in 71% (n = 65) and in 89% (n = 82) after reinterventions
- result Smoking emerged as a significant risk factor for fistula closure failure, OR = 6.75, 95% CI = [1.65, 27.69], p = 0.030.
- result Prolonged oral antibiotics demonstrated a significant protective effect against wound dehiscence, OR = 0.31, 95% CI = [0.10, 0.96], p = 0.036.
- followUp after a median follow-up of 19.3 months
Updates Surg · PMID 40335785 · Read it on PubMed ↗
Yang et al. 2024
Medium- to long-term outcomes of seton placement for fistula-in-ano in children: the experience of 103 patients from a single institution
Treated existing fistulas, not prevention.RetrospectiveLow qualityRelated question
103 people23 (6-58) months
97 of 103 children healed well, 4 healed after further dressing changes and debridement, and 2 with multiple fistulas had recurrence needing a second seton placement
Who was studied
children with anal fistula (fistula-in-ano), average onset age about 16 months
What they received
seton placement for an already-formed anal fistula
Main outcome
healing of the fistula after seton placement
Quality
This is a retrospective, single-institution case series with no comparison group, so it cannot show whether seton placement prevents fistulas or compares favorably to other approaches.
Limitations
Retrospective design, no control group, and it treats fistulas that have already formed rather than testing a method to prevent fistula formation after abscess drainage.
Taken word for word from the abstract
- n Among the 103 patients
- population children with anal fistula
- population the median onset age was 16 (3-156) months
- intervention seton placement for anal fistula in children
- primaryOutcome evaluate the efficacy of seton placement for anal fistula in children
- result A total of 97 patients experienced good healing, four patients experienced poor healing and healed after dressing change and debridement, and two patients with multiple fistulas who experienced recurrence underwent a second seton placement.
- design The clinical data of children with anal fistula treated by seton placement admitted from January 2017 to September 2022 were retrospectively analyzed.
Pediatr Surg Int · PMID 39709324 · Read it on PubMed ↗
Neville et al. 2025
Non-operative Versus Operative Management of Perianal Abscess in Infants: A 10-year Retrospective Study at Two Centres in the United Kingdom
Surgery cut recurrence; fistula rates similar.RetrospectiveLow qualityRelated question
116 people3 (IQR 2-6) months
Abscess recurrence was significantly lower after operative management (23%) than non-operative management (53%), and operative management was linked to a reduced risk of recurrence; rates of later fistula formation were not significantly different between the two approaches
Who was studied
Infants aged 12 months or younger with a perianal abscess
What they received
Operative management (incision and drainage) of the abscess
Compared with
Non-operative management (antibiotics and/or aspiration under local anaesthetic)
Main outcome
Whether the abscess came back, and whether a fistula later formed
Quality
This is a retrospective, non-randomised comparison from only two centres, so differences could be due to which infants were chosen for each treatment rather than the treatment itself.
Limitations
Retrospective design with no randomisation, short median follow-up of 3 months, and treatment choice was based on surgeon preference rather than a trial protocol.
Taken word for word from the abstract
- population infants aged ≤12 months presenting with PA
- intervention Initial management was non-operative in 73/116 (63 %) and operative in 43/80 (37 %)
- comparator non-operative treatments, such as antibiotics and/or aspiration under local anaesthetic
- primaryOutcome compare outcomes for non-operative and operative management of infant PA
- result Recurrence occurred in 49/116 (42 %) at a median time of 1 (IQR 0-3) month and was significantly higher in the non-operative compared to the operative group (39/73 [53 %] versus 10/43 [23 %], p = 0.001).
- result Subsequent FIA rates were not significantly different (23/73 [32 %] versus 8/43 [19 %], p = 0.129).
- n 116 infants were identified
- followUp Median follow-up was 3 (IQR 2-6) months.
J Pediatr Surg · PMID 39693822 · Read it on PubMed ↗
Chen et al. 2024
Proposal for a new classification of anorectal abscesses based on clinical characteristics and postoperative recurrence
Delay and preop antibiotics raised recurrence risk.RetrospectiveLow qualityRelated question
525 people1 year
Fistula-prone abscess type, waiting 7 or more days before surgery, chronic diarrhea, preoperative antibiotic use, and local anesthesia were linked to higher recurrence; diabetes was linked to lower recurrence; high BMI raised recurrence risk in non-fistula-prone abscesses
Who was studied
Adults with anorectal or perianal abscess treated with incision and drainage alone at one hospital
Main outcome
Recurrence of abscess or progression to anal fistula within one year after incision and drainage
Quality
It is a single-center retrospective chart review without randomization or comparison of different surgical techniques, so it can only suggest risk factors, not prove what prevents fistula formation.
Limitations
Retrospective design from a single tertiary hospital, no comparison between different prevention strategies (such as primary fistulotomy or seton placement), reliance on electronic medical records which may introduce bias.
Taken word for word from the abstract
- population 525 patients with anorectal abscesses treated by incision and drainage alone, at a tertiary general hospital from August 2012 to July 2022, were included
- n 525 patients with anorectal abscesses
- primaryOutcome One year post-follow-up, the overall recurrence rate was 39%:81.0% and 23.5% for fistula-prone and non-fistula-prone abscesses, respectively.
- result Fistula-prone abscess, ≥ 7 days between symptom onset and surgery, chronic diarrhea, preoperative antibiotic use, and local anesthesia were risk factors for recurrence, while diabetes mellitus was protective (P < 0.05).
- result Body mass index ≥ 28 (OR = 2.935, 95%CI: 1.203-7.165, P = 0.018) was an independent risk factor for postoperative recurrence of non-fistula-prone abscess.
World J Gastrointest Surg · PMID 39649212 · Read it on PubMed ↗
Ignat'ev et al. 2024
[Surgical treatment of perianal abscess and fistula-in-ano in neonates and infants]
Fistulotomy at drainage cut recurrence more.RetrospectiveLow qualityRelated question
31 people1 year
Cure rate was higher and recurrence was lower with the Gabriel procedure (fistulotomy) than with incision and drainage alone
Who was studied
neonates and infants aged 1-12 months with their first perianal abscess and fistula-in-ano
What they received
Gabriel procedure (incision and drainage plus fistulotomy)
Compared with
incision and drainage alone without fistulotomy
Main outcome
cure rate and recurrence of abscess/fistula after surgery
Quality
It is a small, single-center retrospective study without randomization, and all patients already had a confirmed fistula rather than being studied to see if fistula formation could be prevented.
Limitations
Retrospective design, small sample (31 boys), single center, and all patients already had fistula-in-ano confirmed at enrollment rather than being followed to see if fistula could be prevented.
Taken word for word from the abstract
- population neonates and infants aged 1-12 months with first occuring perianal abscess and fistula-in-ano
- intervention Gabriel procedure (GP)
- comparator incision and drainage of perianal abscess (ID) without fistulotomy
- primaryOutcome The cure rate in the OG group (100%, 18/18) was significantly higher than in the ID group (54%, 7/13; p=0.002).
- result Abscess recurrence was significantly less common in the OG group (p=0.002).
- n The study included 31 boys (13 ones in the ID group, and 18 ones in the GP group).
Khirurgiia (Mosk) · PMID 39584513 · Read it on PubMed ↗
Kata et al. 2024
Anorectal Abscess
No clear way to prevent fistula yetNarrative reviewLow quality
size not given2024
Antibiotics are only advised for extensive cellulitis, systemic infection, or immunocompromise, and whether they prevent fistula formation is still being studied; primary fistulotomy at the time of drainage is controversial; overall patients have a 30 to 50% chance of developing a fistula after drainage
Who was studied
people who have had an anorectal abscess drained
Main outcome
risk of developing an anal fistula after abscess drainage
Quality
This is a narrative review summarizing existing evidence and opinion rather than presenting new comparative data, so it cannot show which approach actually works best.
Limitations
The abstract is a general review without original patient data, a defined study population size, or a controlled comparison between prevention strategies.
Taken word for word from the abstract
- population Anorectal abscesses are a common colorectal emergency.
- primaryOutcome decreasing the risk of complex fistula formation
- result Use of antibiotics should be reserved for those with extensive cellulitis, signs of systemic infection, or patients who are immunocompromised. Whether antibiotics prevent future fistula formation is an area of active research. Primary fistulotomy at time of the index drainage is controversial; however, there may be situations where it is appropriate.
- result they have a 30 to 50% chance of developing an anal fistula that will then require further treatment
Clin Colon Rectal Surg · PMID 39399133 · Read it on PubMed ↗
Akinmoladun et al. 2024
Anal Cryptoglandular Suppuration: Evidence-Based Management
No specific findings reported.Narrative reviewLow qualityRelated question
size not given2024
The abstract describes that treating anal abscess/fistula requires balancing fecal incontinence risk from simple fistulotomy against higher recurrence risk with sphincter-sparing treatments, but gives no specific comparative data on prevention measures like primary fistulotomy, seton placement, antibiotics, or wound packing.
Who was studied
adults with anal abscesses or fistula-in-ano
Main outcome
balancing risk of fecal incontinence versus fistula recurrence when treating anal suppuration
Quality
This is a narrative review with no original data, specific study results, or quantitative comparisons reported.
Limitations
No original research data, no specific outcomes, numbers, or comparative results are reported for any prevention strategy.
Taken word for word from the abstract
- population Anal suppurative processes are commonly encountered in surgical practice.
- primaryOutcome Balancing the risk of fecal incontinence with simple fistulotomy versus the higher risk of fistula recurrence with all sphincter-sparing fistula treatments can be a challenge for surgeons and patients alike.
- result Balancing the risk of fecal incontinence with simple fistulotomy versus the higher risk of fistula recurrence with all sphincter-sparing fistula treatments can be a challenge for surgeons and patients alike.
Surg Clin North Am · PMID 38677815 · Read it on PubMed ↗
Turner et al. 2024
Management of acute perianal abscess: is surgeon specialization associated with improved outcomes?
Surgeon specialty made no difference.RetrospectiveLow qualityRelated question
408 people2024
no difference in the chance of the abscess coming back between surgeon types, even though colorectal surgeons found and treated a hidden fistula more often at the first operation
Who was studied
adults with an acute perianal abscess treated in hospital, excluding those with inflammatory bowel disease, recent fistula treatment, or non-gland-related infections
What they received
abscess managed by a colorectal-specialist surgeon
Compared with
abscess managed by a non-colorectal general surgeon
Main outcome
abscess coming back after treatment
Quality
it is a retrospective comparison of surgeon type (not of a specific prevention technique) with acknowledged selection bias, so it cannot reliably show whether any preventive technique works.
Limitations
Retrospective cohort design with potential selection bias; compares surgeon specialization rather than a specific preventive technique like fistulotomy, seton, antibiotics or packing.
Taken word for word from the abstract
- population Patients with perianal abscess admitted to the ASU between 2016 and 2020 were identified from a prospective database and their medical records reviewed. Patients with IBD, treatment for fistula-in-ano within the preceding year, or perianal sepsis of non-cryptoglandular origin were excluded.
- intervention Patients admitted under an ASU colorectal (CR) consultant were compared with those under a non-CR general surgeon in a retrospective cohort study.
- comparator Patients admitted under an ASU colorectal (CR) consultant were compared with those under a non-CR general surgeon in a retrospective cohort study.
- primaryOutcome Primary outcome was perianal abscess recurrence.
- result Cox multivariable analysis found no difference in hazard of recurrent abscess between groups (HR 1.12, 95% CI 0.65-1.95, P = 0.681)). Abscess recurred in 18.7% CR and 15.5% non-CR.
- result The CR group more frequently had a fistula identified at index operation (34.0% versus 10.9%, P < 0.0001).
- n Four-hundred and eight patients were included (150 CR, 258 non-CR).
ANZ J Surg · PMID 38131396 · Read it on PubMed ↗
Skovgaards et al. 2023
Fistula development after anal abscess drainage-a multicentre retrospective cohort study
Identified risk factors, not prevention methodsRetrospectiveLow qualityRelated question
475 peoplemedian follow-up time of 1108 days (IQR 946-1320 days)
Several factors were linked to higher odds of later fistula, including abscess type and location, Crohn's disease, repeat abscesses or surgery, certain bacteria in the pus, and high inflammation markers; no specific preventive technique was tested
Who was studied
adults having surgery for anal abscess in Denmark
Main outcome
whether patients later developed an anal fistula after abscess drainage
Quality
This is a retrospective record review that identifies associations with fistula risk but does not test or compare any preventive surgical or medical technique.
Limitations
Retrospective design based on patient records, no comparison of different prevention strategies, and findings are associations rather than tested interventions.
Taken word for word from the abstract
- n A total of 475 patients were included.
- population patients undergoing acute surgery for anal abscesses in the Capital Region of Denmark between 2018 and 2019
- primaryOutcome 164 (33.7%) patients were diagnosed with an anal fistula
- result Risk factors for developing fistulas were low intersphincteric (OR 2.77, 95CI 1.50-5.06) and ischioanal (OR 2.48, 95CI 1.36-4.47) abscesses, Crohn's disease (OR 5.96, 95CI 2.33-17.2), a history of recurrent anal abscesses (OR 4.14, 95CI 2.47-7.01) or repeat surgery (OR 5.96, 95CI 2.33-17.2), E. coli-positive pus cultures (OR 4.06, 1.56-11.4) or preoperative C-reactive protein (CRP) of more than 100 mg/L (OR 3.21, 95CI 1.57-6.71).
Int J Colorectal Dis · PMID 38093036 · Read it on PubMed ↗
Reza et al. 2024
European Society of Coloproctology: Guidelines for diagnosis and treatment of cryptoglandular anal fistula
No specific findings reported hereGuidelineLow qualityRelated question
size not given2024
The abstract describes the process used to create the guideline and states it produced 42 recommendations in seven sections, but does not report any specific findings, data, or recommendations about preventing fistula formation after abscess drainage
Who was studied
Adults with perianal abscess or anal fistula caused by anal gland infection, seen in hospital specialist care
Main outcome
Not specified for this question; the guideline lists fistula healing, recurrence and incontinence as critical outcomes overall
Quality
This is a description of how a guideline was developed, not a report of study results, so it gives no usable evidence about preventing fistula formation.
Limitations
The abstract only describes guideline methodology (scope, panel composition, literature search process) and does not report the actual recommendations or supporting data for preventing fistula formation.
Taken word for word from the abstract
- population addresses the diagnostic and therapeutic management of perianal abscess and cryptoglandular anal fistula in adult patients presenting to secondary care
- result In seven sections covering the diagnostic and therapeutic management of perianal abscess and cryptoglandular anal fistula, there are 42 recommendations.
- primaryOutcome Critical outcomes were fistula healing, fistula recurrence and incontinence.
Colorectal Dis · PMID 38050857 · Read it on PubMed ↗
Yin et al. 2023
Natural course of perianal abscess in infants: a real-world study
Most infants healed without surgery; some developed fistulas.RetrospectiveLow qualityRelated question
153 peoplemedian follow-up was 5.3 years (range 3-8.2 years)
77.8% were cured initially with conservative treatment; overall 90.8% were cured without surgery, 7.2% eventually needed surgery, and fistula-in-ano developed in 15.0% after conservative treatment (2.0% overall)
Who was studied
infants with perianal abscess whose parents refused surgery, treated conservatively
What they received
conservative (non-surgical) management of the abscess for more than 2 months
Main outcome
cure without surgery, and rate of fistula formation, abscess recurrence or new abscess
Quality
This is a retrospective single-center study of infants who were conservatively managed only because parents refused surgery, so it does not test any specific fistula-prevention technique and is prone to selection bias.
Limitations
Retrospective design, single center, selection based on parental refusal of surgery rather than randomization, and population limited to infants rather than the general population with anorectal abscess.
Taken word for word from the abstract
- population infants with PA who were treated conservatively (due to the parents' refusal of surgery), for more than 2 months between 2014 and 2020 at a single tertiary center
- n 153 patients (149 boys and 4 girls) were identified
- intervention infants with PA who were treated conservatively
- primaryOutcome the rate of fistula formation, abscess recurrence, and new-onset abscess were 15.0%, 4.6%, and 6.5%, respectively
- result Initially, 119 patients (77.8%) were completely cured by conservative treatment, and 34 (22.2%) failed.
- result Overall, 139 patients (90.8%) were cured conservatively without surgery, and 11 (7.2%) underwent surgical management.
- result In addition, 3 (2.0%) patients developed fistula-in-ano (under observation).
- followUp The median follow-up was 5.3 years (range 3-8.2 years).
Sci Rep · PMID 37891236 · Read it on PubMed ↗
Dong et al. 2023
Study on the factors influencing the prognosis after perianal abscess surgery
Simple drainage linked to more fistulas.RetrospectiveLow qualityRelated question
394 people2023
Patients who had simple incision and drainage were more likely to have recurrence or fistula formation than those treated with more thorough surgery addressing the internal opening; larger abscess extent and surgical method were independent risk factors for poor outcome
Who was studied
adults with perianal abscess who underwent surgery
What they received
surgical approach used for abscess drainage, including simple drainage versus more thorough surgery addressing the internal opening/abscess glands
Compared with
different surgical methods and preoperative evaluation approaches (e.g., with or without MRI) compared retrospectively
Main outcome
postoperative recurrence of abscess or formation of an anal fistula
Quality
This is a retrospective review of medical records using statistical risk-factor analysis rather than a controlled trial, so it can show associations but not prove that one surgical approach causes better outcomes.
Limitations
Retrospective design, no randomization, groups differed in many baseline factors, and the specific surgical techniques being compared are not clearly defined.
Taken word for word from the abstract
- n The clinical data of 394 patients with perianal abscesses were collected
- population patients with perianal abscesses
- intervention the proportion of patients in the uncured group who underwent simple drainage (51.16%) was higher than in the cured group (28.49%)
- comparator the proportion of patients in the uncured group who underwent magnetic resonance imaging (MRI) before surgery (27.90%) was lower than in the cured group (45.30%)
- primaryOutcome the influence of clinical characteristics and diagnosis and treatment methods of perianal abscess on postoperative recurrence or formation of anal fistula
- result the extent of the abscess cavity (OR = 2.544, 95%CI = 1.087-5.954, p = 0.031) and the surgical method (OR = 2.180, 95%CI = 1.091-4.357, p = 0.027) were independent influencing factors for postoperative recurrence of perianal abscess or anal fistula
BMC Gastroenterol · PMID 37759161 · Read it on PubMed ↗
Besendörfer et al. 2023
Treatment of pediatric fistula-in-ano-Sphincter-sparing non-cutting seton placement as the future treatment of choice?
Study treats existing fistulas, not prevention.RetrospectiveLow qualityRelated question
42 people4.9 years
Among 42 children treated with a non-cutting seton for an existing fistula, 7% had the fistula return (only in infants), some had recurrent abscess, and two children who already had fecal incontinence before surgery kept it afterward; no significant differences were seen between age groups.
Who was studied
children with an already-diagnosed anal fistula
What they received
non-cutting, sphincter-sparing seton placement
Main outcome
fistula coming back or abscess coming back after treatment
Quality
This is a small retrospective single-group study of children already diagnosed with fistula, not a study comparing ways to prevent fistulas from forming, so it says little about prevention.
Limitations
Retrospective, no comparison group without seton, small sample, and the abstract explicitly calls for further prospective studies.
Taken word for word from the abstract
- population Therapeutic principles of fistula-in-ano (FIA)
- intervention non-cutting seton placement
- primaryOutcome outcome variables of recurrent FIA and recurrent perianal abscess
- result Overall recurrence rate of FIA within an observation time of 9 months postsurgically was at 7% (n = 3/42) and was only seen in infancy, whereas recurrent perianal abscess was mainly observable in children (n = 2, p = 0.2132).
- n Of the 42 included patients, 37 responded in the follow-up analysis
- followUp median follow-up time of 4.9 years
Front Surg · PMID 37114148 · Read it on PubMed ↗
Durgun et al. 2023
The use of a loose seton as a definitive surgical treatment for anorectal abscesses and complex anal fistulas
Seton use, no fistula recurrence seen.RetrospectiveLow qualityRelated question
114 people18 (6-30) months
No recurrent fistulas were seen in either group; recurrent abscesses occurred in 13.9% of the abscess group and insufficient-drainage abscesses in 2.6% of the fistula group, with no difference in continence between groups
Who was studied
adults treated for anorectal abscesses or complex anal fistulas with a loose seton
What they received
loose seton placement during surgery for abscess or fistula
Compared with
comparison between two patient groups (chronic complex fistula vs abscess with fistula) rather than seton vs no seton
Main outcome
continence, fistula recurrence, and recurrent abscess formation
Quality
This is a retrospective, single-center study without a comparison group that did not receive a seton, so it cannot show whether the seton itself prevented fistula formation.
Limitations
Retrospective design, no control group without seton, single center, and it studies seton as treatment for existing fistulas/abscesses rather than as a preventive measure during initial drainage.
Taken word for word from the abstract
- population 114 patients who were operated on in our clinic due to chronic anal fistulas and anorectal abscesses with an applied loose seton between 2020 and 2022 were included in the study
- intervention the loose seton method for the treatment of chronic anal fistulas and acute anorectal abscesses accompanied by anal fistula
- comparator The patients were divided into 2 groups: those with chronic complex anal fistula and those with anorectal abscess accompanied by anal fistula.
- primaryOutcome compared in terms of their continence status, rate of recurrence, recurrent abscess formation, postoperative pain scores, duration of operation, and demographic characteristics
- result No recurrent fistulas were observed in patients during the follow-up period. Recurrent abscesses were observed in 5 (13.9%) patients in the anorectal abscess group. Abscesses due to insufficient drainage were observed in 2 (2.6%) patients in the chronic fistula group.
- n 114 patients who were operated on in our clinic due to chronic anal fistulas and anorectal abscesses with an applied loose seton
Adv Clin Exp Med · PMID 36920266 · Read it on PubMed ↗
Lin et al. 2023
The Optimal Primary Treatment for Pediatric Perianal Abscess and Anal Fistula: A Systemic Review and Meta-Analysis
Surgery cut recurrence more than drainage alone.Meta-analysisLow qualityRelated question
2,507 people2023
Surgery lowered recurrence compared with simple incision and drainage (OR 4.360, p=0.001); conservative (non-surgical) treatment had a higher recurrence risk than surgery, though not statistically significant (OR 0.278, p=0.007); conservative treatment and drainage alone showed no difference (OR 1.222, p=0.567).
Who was studied
children and teenagers (under 18) with a perianal abscess with or without an anal fistula
Main outcome
recurrence after the first treatment for the abscess or fistula
Quality
The review pooled mostly retrospective studies with no randomized trials, and the authors themselves say strong recommendations cannot be made.
Limitations
No randomized controlled trials were found; most included studies were retrospective; subgroup analysis of specific surgical or conservative approaches could not be performed due to lack of information.
Taken word for word from the abstract
- population patient age of <18 years
- n Thirty-one studies involving 2507 pediatric patients met the inclusion criteria.
- primaryOutcome Meta-analyses for recurrence after initial management were performed with a random-effects model.
- result Compared with incision/drainage, surgery can prevent recurrence remarkably (OR 4.360, 95% CI: 1.761-10.792, p = 0.001).
- result Conservative management had a higher risk of recurrence than surgery without statistical significance (OR 0.278, 95% CI: 0.109-0.707, p = 0.007).
- result Conservative treatment and drainage revealed no difference (Odds ratio [OR], 1.222; 95% Confidential interval [CI]: 0.615-2.427, p = 0.567).
- limitations Strong recommendations cannot be made due to the lack of prospective or randomized controlled studies.
J Pediatr Surg · PMID 36894443 · Read it on PubMed ↗
Doerner et al. 2022
Risk factors for therapy failure after surgery for perianal abscess in children
Probing and fistulotomy cut recurrence risk.RetrospectiveLow quality
103 people2022
Fistula probing was independently linked to treatment success, while a past history of perianal abscess was linked to treatment failure
Who was studied
children under 14 who had surgery for a perianal abscess
What they received
performing anal fistula probing (and fistulotomy if a fistula was found) at the time of abscess surgery
Compared with
not performing fistula probing or fistulotomy
Main outcome
recurrence of perianal abscess or development of a fistula
Quality
This is a retrospective chart review without randomization, so other differences between the children could explain the results rather than the procedures themselves.
Limitations
Retrospective design, no randomization or control over who received probing or fistulotomy, single cohort over a long time period (2000-2018), possible confounding factors.
Taken word for word from the abstract
- n Out of 103 enrolled patients
- population all children younger than age 14 requiring surgery for a perianal abscess from 2000 to 2018
- intervention Anal fistula probing was performed in 33% of all patients, of which 16 (15%) underwent fistulotomy.
- comparator Anal fistula probing was performed in 33% of all patients
- primaryOutcome 27 (26%) had recurrent perianal disease
- result In multivariate analysis, anal fistula probing was independently associated with treatment success (p = 0.019, OR = 22.08), while the history of perianal abscess was associated with treatment failure (p = 0.002, OR = 0.032).
Front Surg · PMID 36589625 · Read it on PubMed ↗
Bender et al. 2022
Drug resistant bacteria in perianal abscesses are frequent and relevant
Resistant bacteria linked to worse, slower healingRetrospectiveLow qualityRelated question
817 people2022
Patients whose abscess pus grew drug-resistant bacteria had more severe disease, more complicated fistulas needing drainage at the first operation, more repeat surgeries, and took longer to get definitive fistula repair than patients without resistant bacteria
Who was studied
Adults and adolescents (12 years and older) treated surgically for a perianal abscess at one hospital between 2008 and 2019
Main outcome
Whether bacteria from the abscess pus were resistant to antibiotics, and how this related to disease severity and fistula outcomes
Quality
This is a retrospective, observational study that looked at bacteria and outcomes together without testing any specific way to prevent a fistula, so it cannot show whether changing antibiotics or surgical technique would actually prevent fistula formation.
Limitations
Retrospective design, no randomization or defined prevention intervention, and the bacteria findings may simply reflect that sicker patients both have worse infections and worse outcomes rather than showing a causal effect on fistula prevention.
Taken word for word from the abstract
- population consecutive patients (≥ 12 years of age) from a tertiary care hospital, who underwent surgical treatment for perianal abscess from 01/2008 to 12/2019
- n no microbiological testing of purulence (No_Swab, n = 456), no detection of drug resistant bacteria [DR(-), n = 141] or detection of bacteria with acquired drug resistances from purulence [DR(+), n = 220]
- primaryOutcome Fistula persistence was estimated by Kaplan Meier and compared between the groups using Log rank test.
- result Higher pretherapeutic C-reactive protein (p < 0.0001) and white blood cell count (p < 0.0001), higher rates of supralevatoric or pararectal abscesses (p = 0.0062) and of complicated fistula-in-ano requiring drainage procedure during index surgery (p < 0.0001) reflect more severe diseases in DR(+) patients.
- result the duration until definitive fistula repair was the longest in DR(+) patients (p = 0.0061)
Sci Rep · PMID 36050427 · Read it on PubMed ↗
Kang et al. 2022
Intermediate-Term Evaluation of Initial Non-Surgical Management of Pediatric Perianal Abscess and Fistula-In-Ano
No difference in fistula formation.RetrospectiveLow qualityRelated question
457 people2022
no significant difference in fistula formation or abscess recurrence between children treated surgically versus non-surgically, with fewer hospital admissions and procedures in the non-surgical group
Who was studied
children with a first-time perianal abscess or anal fistula
What they received
non-surgical management (no incision/drainage surgery)
Compared with
surgical incision and/or drainage
Main outcome
rates of abscess recurrence and new fistula formation
Quality
this is a retrospective comparison without randomization, so differences between groups could reflect which children were chosen for each treatment rather than the treatment itself.
Limitations
retrospective design, non-randomized allocation to surgical vs non-surgical groups, pediatric population only, and no detail on specific fistula-prevention techniques like seton placement or fistulotomy timing
Taken word for word from the abstract
- population A study of pediatric patients with first-time PA and/or FIA was conducted retrospectively from January 2010 to December 2020.
- n A total of 457 patients managed for first-time PA and/or FIA were eligible for the current study.
- intervention Of these patients, 169 (50.9%) patients received non-surgical intervention.
- comparator compare the intermediate-term outcomes of non-surgical management with those of surgical incision and/or drainage
- primaryOutcome The clinical outcomes, including PA recurrence, FIA formation, and wound healing time, were compared between the surgical and non-surgical management groups.
- result no difference was noted between the two groups in terms of PA recurrence and/or FIA development rates and revisits for additional treatment
- result non-surgical intervention exhibited promising outcomes for most cases of first-time PA/FIA, with fewer hospital admissions and surgical procedures and similar recurrence and fistula formation incidences
Surg Infect (Larchmt) · PMID 35647894 · Read it on PubMed ↗
Chaveli Díaz et al. 2022
Recurrence and incidence of fistula after urgent drainage of an anal abscess. Long-term results
High recurrence and fistula rates after drainage aloneProspective cohortLow qualityRelated question
303 peopleMean follow-up 119.7 months
Nearly half of patients (48.2%) had a recurrence, mostly within the first year, and 40.3% overall developed a fistula; fistula was more common when symptoms persisted or the abscess recurred
Who was studied
adults with an anal abscess caused by infected anal glands, treated with urgent drainage
Main outcome
rate of abscess recurrence and development of an anal fistula after drainage
Quality
this is a single-center observational study that tracked outcomes after abscess drainage but did not compare any specific fistula-prevention techniques, so it cannot show which approach works.
Limitations
Retrospective review of a cohort, no comparison between different preventive techniques (e.g. fistulotomy, seton, antibiotics), single center.
Taken word for word from the abstract
- n All patients (n = 303) were evaluated two months and one year after the intervention.
- population Retrospective observational study of a prospective cohort with anal abscess of cryptoglandular origin.
- primaryOutcome 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.
- result Recurrence rate 48.2% (82.2% in the first year).
- result Global incidence of fistula 40.3%.
- result The fistula is statistically more frequent if the abscess recurs (p < 0.001).
- followUp Mean follow-up 119.7 months.
Cir Esp (Engl Ed) · PMID 34876366 · Read it on PubMed ↗
Hasan et al. 2023
Incidence of anal fistula after pyogenic perianal abscess drainage in Kingdom of Bahrain
About 1 in 3 developed fistulaRetrospectiveLow qualityRelated question
109 people2023
A fistula developed in 33.9% of patients after abscess drainage, most within 6 months
Who was studied
Adults with perianal (anorectal) abscess who had the abscess drained
Main outcome
Whether a fistula developed after abscess drainage
Quality
This is a small, single-center retrospective chart review that only reports how often fistulas occurred, without comparing any prevention techniques like fistulotomy, seton placement, or antibiotics.
Limitations
Retrospective design, single center, relies on electronic records and phone calls, and does not test or compare any specific prevention method.
Taken word for word from the abstract
- population A total of 109 patients with a diagnosis of anal abscess were included between 2015 and 2018.
- n A total of 109 patients with a diagnosis of anal abscess were included between 2015 and 2018.
- primaryOutcome A fistula developed following abscess drainage in 33.9% of patients.
- result A fistula developed following abscess drainage in 33.9% of patients. Most fistulas (37.8%) were diagnosed within 6 months or less from abscess drainage.
Ann Coloproctol · PMID 34376025 · Read it on PubMed ↗
Sørensen et al. 2021
Needle aspiration treatment vs. incision of acute simple perianal abscess: randomized controlled study
No difference in fistula rates.Randomised trialModerate qualityRelated question
98 people52 weeks
Fistula formation occurred in 15% of patients overall, with no significant difference between needle aspiration and incision drainage; needle aspiration had a higher abscess recurrence rate than incision drainage
Who was studied
adults with an acute perianal abscess
What they received
needle aspiration of the abscess plus a week of antibiotics
Compared with
conventional surgical incision and drainage
Main outcome
abscess coming back (recurrence), with fistula formation as a secondary outcome
Quality
This was a randomized trial across three centers with good follow-up, but it was not designed primarily to study fistula prevention, and the fistula outcome itself showed no significant difference between groups.
Limitations
Fistula formation was a secondary outcome, not the primary focus; the trial compared two drainage techniques (needle aspiration vs incision) rather than specifically testing fistula-prevention adjuncts like fistulotomy, seton placement, or packing.
Taken word for word from the abstract
- population This is a three-center randomized controlled trial, including adults with acute perianal abscess.
- intervention The needle aspiration group received clindamycin for one week postoperatively.
- comparator compare the outcome of needle aspiration and postoperative antibiotics with that of conventional surgical incision drainage of acute perianal abscess
- primaryOutcome The primary outcome was abscess recurrence. Secondary outcomes were fistula formation, wound healing, quality of life, and fecal continence.
- result Fistula formation was 15% without significant difference between the groups.
- n A total of 98 patients were included.
Int J Colorectal Dis · PMID 33447866 · Read it on PubMed ↗
Arroyo-Martinez et al. 2020
Urgent care practice in anorectal abscess. Still a pending task
No practice reduced recurrence; fistula raised recurrence risk.RetrospectiveLow qualityRelated question
190 people2020
Across 190 patients, practices varied widely (antibiotics given in 62.9%, referral to specialist clinic in 41.1%), but none of these practice variables were linked to recurrence; the only factor associated with recurrence was having an associated anal fistula.
Who was studied
adults treated in the emergency department for an anorectal abscess
What they received
usual emergency department care for anorectal abscess, including simple drainage, antibiotic use, and referral to a specialist clinic
Main outcome
recurrence of the abscess
Quality
This is a retrospective, single-center review of existing practice without a controlled comparison of any specific fistula-prevention technique, so it cannot show whether any approach prevents fistula formation.
Limitations
Retrospective, single-center design; studies abscess recurrence rather than new fistula formation; does not test a specific preventive technique such as primary fistulotomy or seton placement.
Taken word for word from the abstract
- design this was retrospective and unicentric study
- n corresponding to 190 patients, 129 males (mean age 46 ± 14.9 years)
- population Patients who underwent surgery for AA between 2016 and 2017 were included in the study
- intervention The most frequent treatment in the emergency department (ED) was simple drainage (75.8%). Antibiotic therapy was prescribed in 62.9% of the cases. A total of 41.1% of the patients were referred to a specialized COD.
- primaryOutcome The recurrence risk factors were also evaluated.
- result The only risk factor associated with recurrence was the presence of an associated anal fistula.
- result There is great clinical variability regarding the taking of cultures, prescription of antibiotics, and referral criteria to a specialized coloproctology outpatient department, without clear impact of any of them on the recurrence of the abscess.
Cir Cir · PMID 33254180 · Read it on PubMed ↗
Gokce et al. 2020
Can the risk of anal fistula development after perianal abscess drainage be reduced?
Hospital wound care lowered fistula risk.RetrospectiveLow quality
size not given1 year
fistula formation was significantly lower in the group that had in-hospital washing and dressing than in the group that had home dressing changes
Who was studied
adults who had a perianal abscess drained
What they received
dressing changes done in hospital with washing of the area after drainage
Compared with
dressing changes done at home with a povidone-iodine sitz bath
Main outcome
development of an anal fistula after abscess drainage
Quality
this was a retrospective review of hospital records without a reported sample size, so the comparison between groups is weaker and open to bias.
Limitations
retrospective design, no patient numbers given, single center, authors call for a large prospective study to confirm the findings
Taken word for word from the abstract
- population The records of patients who underwent drainage of perianal abscesses between January 2015 and January 2018 were retrospectively reviewed.
- intervention Patients with postoperative dressings changed with washing of the area in the hospital were included as Group 1.
- comparator Patients with dressings changed at home and the area bathed in 10% povidone-iodine sitz bath were included as Group 2.
- primaryOutcome The frequency and time of fistula formation, age, sex, cost, and workdays lost in the two groups were compared.
- result During follow-up, fistula development was significantly lower in Group 1 than in Group 2 (p < 0.001).
Rev Assoc Med Bras (1992) · PMID 32935802 · Read it on PubMed ↗
Stokes et al. 2020
Management of perianal abscesses in infants without general anaesthesia: a systematic review of the literature
Most abscesses healed without surgery; some became fistulas.Systematic reviewLow qualityRelated question
1,049 people2020
75.3% healed completely without further treatment, 23.2% had recurrence or progressed to a fistula, and 5.6% eventually needed general anaesthesia
Who was studied
infants younger than 24 months with perianal abscesses
What they received
management of the abscess without general anaesthesia (antibiotics, baths, needle aspiration, drainage under local anaesthesia, etc.)
Main outcome
the number of patients requiring general anaesthesia after initial non-GA management
Quality
The evidence comes mostly from retrospective cohort studies with no randomized trials, so it cannot reliably show which approach best prevents fistula formation.
Limitations
No randomized controlled trials; mixed and poorly standardized treatment modalities; lack of well-designed prospective studies.
Taken word for word from the abstract
- population infants less than 24 months with perianal abscesses
- intervention Treatment modalities included antibiotics, regular baths, needle aspiration, incision and drainage under local anaesthesia, hainosankyuto and fibroblast growth factor.
- primaryOutcome The primary outcome was the number of patients requiring GA following initial management without GA.
- n Nine studies, involving 1049 infants less than 24 months old met inclusion criteria.
- result A total of 790 (75.3%) healed primarily without further intervention. A total of 243 (23.2%) were documented to have a recurrence or progression to FIA.
- result Of these, 59 (5.6%) were documented to subsequently require a general anaesthetic.
Pediatr Surg Int · PMID 32785778 · Read it on PubMed ↗
Mohamedahmed et al. 2021
Incision and drainage of cutaneous abscess with or without cavity packing: a systematic review, meta-analysis, and trial sequential analysis of randomised controlled trials
Packing wound didn't lower fistula riskMeta-analysisModerate qualityRelated question
485 peoplemaximum follow-up period (not specified in days/weeks)
no significant difference in fistula formation between packing and not packing
Who was studied
patients having incision and drainage of a cutaneous abscess (including some anorectal/perianal cases)
What they received
packing the abscess cavity after incision and drainage
Compared with
not packing the abscess cavity after incision and drainage
Main outcome
development of an anal fistula after abscess drainage
Quality
it pools several randomised trials, but the study population is mostly general skin abscesses rather than anorectal abscesses specifically, and the trial sequential analysis shows the findings are not yet statistically conclusive.
Limitations
Trial Sequential Analysis showed the meta-analysis was not conclusive and recurrence results were subject to type 2 error; most patients had cutaneous (not specifically anorectal) abscesses.
Taken word for word from the abstract
- population Eight RCTs reporting a total number of 485 patients who underwent incision and drainage of cutaneous abscess with (n = 243) or without (n = 242) packing of the abscess cavity were included.
- intervention incision and drainage of cutaneous abscess with and without packing of the abscess cavity
- comparator without packing
- primaryOutcome development of fistula in-ano were the evaluated outcome parameters for the meta-analysis
- result There was no significant difference in the risk of recurrence (risk ratio (RR) 1.31, P = 0.56), fistula-in-ano (RR 0.63, P = 0.28), and need for second intervention (RR 0.70, P = 0.05) between two groups.
- n Eight RCTs reporting a total number of 485 patients
Langenbecks Arch Surg · PMID 32740696 · Read it on PubMed ↗
Boenicke et al. 2020
Efficacy of conservative treatment of perianal abscesses in children and predictors for therapeutic failure
Conservative treatment often failed; no clear fistula dataRetrospectiveLow qualityRelated question
113 peoplemedian 34 months (range, 3 to 145 months) for conservative treatment relapse
Only 14 of 113 children achieved permanent success with conservative treatment alone; recurrence rates were similar after surgery whether treated with primary surgery (25%) or after failed conservative treatment (22%); larger abscess size predicted conservative treatment failure
Who was studied
Children under 14 years old with perianal abscess treated between 2001 and 2016
What they received
Conservative (non-surgical) treatment of the abscess, such as antibiotics without drainage
Compared with
Primary surgical drainage of the abscess
Main outcome
Whether treatment permanently resolved the abscess without recurrence, and later recurrence (not specifically fistula formation)
Quality
This is a retrospective chart review without randomization, so treatment choice and outcomes could be influenced by unmeasured factors, and it does not directly report on fistula formation.
Limitations
Retrospective design, no randomization between treatment groups, and the abstract reports abscess recurrence rather than fistula formation specifically
Taken word for word from the abstract
- n Of the 113 enrolled patients
- population All cases of children younger than 14 years of age with perianal abscesses between 2001-2016 were evaluated.
- intervention Conservative treatment was initiated in 49 patients
- comparator 64 underwent subsequent surgery for advanced disease (primary surgery group)
- primaryOutcome To evaluate the efficiency of conservative treatment of perianal abscess in children and identify parameters that predict therapy failure.
- result Overall, conservative treatment alone was effective in only 14 of 113 patients.
- result Recurrence after surgery occurred in 16 patients (25%) in the primary surgery group and 11 patients (22%) in the primary conservative group (P=0.75).
Clin Exp Pediatr · PMID 32408417 · Read it on PubMed ↗
Erol et al. 2020
Preventing the recurrence of acute anorectal abscesses utilizing a loose seton: a pilot study
Fewer recurrences with seton or fistulotomyProspective cohortLow quality
44 people12 months
No recurrences occurred when loose seton or fistulotomy was done at the same time as drainage, whereas drainage alone led to recurrence in most patients (58.8%), a highly significant difference.
Who was studied
adults with anorectal (perianal) abscesses needing drainage, some with high or low fistula tracts
What they received
drainage combined with a loose seton (for high tracts) or fistulotomy (for low tracts) performed at the same surgery
Compared with
drainage alone with no concomitant seton or fistulotomy
Main outcome
recurrence of anorectal abscess within 12 months
Quality
It is a small, non-randomized pilot study without blinding, so the results could be influenced by selection bias or chance.
Limitations
Small pilot study, no randomization described, and some patients needed further secondary interventions after the seton treatment.
Taken word for word from the abstract
- population treating anorectal abscesses with drainage plus loose seton for possible coexisting high fistulas or drainage plus fistulotomy for low tracts
- intervention Drainage plus fistulotomy were performed only in cases with subcutaneous mucosa, intersphincteric, or apparently low transsphincteric fistula tracts. For all other cases with high transsphincteric fistula or those with questionable sphincter involvement, a loose seton was placed through the tract.
- comparator Drainage only was carried out in 17 patients.
- primaryOutcome None of the patients developed recurrent abscess during a follow-up of 12 months.
- result At 12 months, drainage only was followed by 10 recurrences (58.8 percent; p<0.0001, compared with concomitant surgery).
- n Drainage only was carried out in 17 patients.
- n Twenty-three patients underwent drainage plus loose seton.
- n Drainage plus fistulotomy were performed in four cases.
Pan Afr Med J · PMID 32341739 · Read it on PubMed ↗
Bałaż et al. 2020
Perianal abscess and fistula-in-ano in children - evaluation of treatment efficacy. Is it possible to avoid recurrence?
Fistulotomy prevented recurrence; drainage alone often recurred.RetrospectiveLow quality
24 people2020
All patients who had fistulotomy had no recurrence or incontinence; the minimally invasive approach (drainage alone) was associated with a high recurrence rate
Who was studied
infants and children with perianal abscess
What they received
fistulotomy (surgically opening the fistula tract) at time of abscess treatment
Compared with
minimally invasive approach: sitz baths, antibiotics, puncture or incision and drainage without fistulotomy
Main outcome
recurrence of perianal abscess or fistula, and fecal incontinence
Quality
This was a small retrospective study of only 24 children with no randomization and no direct head-to-head comparison group treated identically except for the intervention.
Limitations
Retrospective design, very small sample size, no randomization, group II patients had prior treatment elsewhere making comparison uneven, pediatric population only.
Taken word for word from the abstract
- population 24 infants with perianal abscess treated at our center between 2013 and 2015
- intervention Fistula-in-ano was intraoperatively identified in all patients (100%) and fistulotomy was performed.
- comparator Minimally invasive approach (sitz baths, antibiotic therapy, puncture or incision and drainage of the abscess) appears tempting due to its simplicity and lack of need for general anesthesia, but it is associated with a high recurrence rate.
- primaryOutcome No fecal incontinence or recurrence of perianal abscess were observed in any of our patients.
- result Fistulotomy and fistulectomy, which are slightly more invasive procedures, significantly reduce the recurrence rate of fistulain- ano and perianal abscess.
- n The retrospective study included 24 infants with perianal abscess treated at our center between 2013 and 2015.
Pol Przegl Chir · PMID 32312918 · Read it on PubMed ↗
La Torre et al. 2020
Lift and VAAFT for high trans-sphincteric anal fistula: a single center retrospective analysis
Compares two fistula surgeries, not prevention at abscess drainageRetrospectiveLow qualityRelated question
54 people18 months
No significant differences between LIFT and VAAFT overall in continence, pain, healing time or recurrence, but among patients who had an abscess at the time of surgery, those who had LIFT had worse failure and recurrence rates than VAAFT
Who was studied
Adults with high trans-sphincteric anal fistula, including some with a perianal abscess present at the time of surgery
What they received
LIFT (ligation of intersphincteric fistula tract) surgery
Compared with
VAAFT (video-assisted anal fistula treatment) surgery
Main outcome
Healing time, fistula recurrence, continence, complications, and postoperative pain
Quality
This is a small, single-center retrospective study comparing two fistula surgeries, not a study of methods to prevent fistula formation during abscess drainage.
Limitations
Retrospective, single-center design with only 54 patients; it studies treatment of already-formed complex fistulas, not prevention of fistula formation at the time of abscess drainage.
Taken word for word from the abstract
- population We include all patients with high trans-sphincteric anal fistula even with abscess at the time of surgery.
- intervention 26 patients underwent LIFT
- comparator 28 underwent VAAFT
- primaryOutcome We compared LIFT and VAAFT in the treatment of complex anal fistulas in terms of healing time, recurrence, continence, morbidity, and postoperative pain
- result During the 18 months of follow-up there were no differences in terms of AM, CCFIS and VAS scores. Days of healing, failure, and recurrence rate were comparable in both groups. The subgroup of patients with local abscess undergoing LIFT showed worse results in terms of failure and recurrence rate (p < 0.05).
- n Fifty-four consecutive patients are undergoing surgery: 26 patients underwent LIFT and 28 underwent VAAFT.
Int J Colorectal Dis · PMID 32300885 · Read it on PubMed ↗
Amato et al. 2020
Evaluation and management of perianal abscess and anal fistula: SICCR position statement
No specific findings reported.GuidelineLow qualityRelated question
size not given2020
The statement reviews existing research and gives evidence-based recommendations for individualized management, but the abstract does not give specific findings or numbers for any particular preventive approach
Who was studied
adults with perianal abscess or anal fistula arising from infection near the anus
Main outcome
best way to manage perianal sepsis to reduce recurrence and preserve bowel control
Quality
this is a position statement summarizing literature and expert recommendations rather than presenting new study data or outcomes.
Limitations
The abstract does not describe the methodology, specific recommendations, or evidence for fistula-prevention measures such as primary fistulotomy, seton placement, antibiotics, or wound packing.
Taken word for word from the abstract
- population Perianal sepsis is a common condition ranging from acute abscess to chronic anal fistula.
- primaryOutcome the risks of recurrence and of impairment of continence still seem to be an unresolved issue
- result This statement reviews the pertinent literature and provides evidence-based recommendations to improve individualized management of patients.
Tech Coloproctol · PMID 31974827 · Read it on PubMed ↗
Samuk et al. 2019
Perianal abscess in infants: Amenable to conservative treatment in selected cases
Most avoided surgery; rare fistula.RetrospectiveLow qualityRelated question
19 peoplemean, 22.4 months
Surgery was avoided in most infants, but one later developed a fistula-in-ano that healed on its own without surgery
Who was studied
Infants under 24 months old with a perianal abscess
What they received
Conservative (non-surgical) management of the abscess, using antibiotics and watchful waiting
Main outcome
Whether the infant later needed surgical drainage or developed a fistula
Quality
It is a small, single-center, retrospective case series with no comparison group and some patients lost to follow-up, so it cannot reliably show whether this approach prevents fistulas.
Limitations
Retrospective, no control group, selected/favorable cases only, small sample, some patients lost to follow-up.
Taken word for word from the abstract
- n Data of 19 patients aged <24 months treated conservatively for perianal abscess at a tertiary hospital in 2014-2018 were retrospectively reviewed.
- population Data of 19 patients aged <24 months treated conservatively for perianal abscess at a tertiary hospital in 2014-2018 were retrospectively reviewed.
- intervention The aim of this study was to evaluate the outcomes of conservative approach in selected cases of perianal abscesses in infants.
- primaryOutcome Thus, surgical intervention was prevented in 13/17 patients (76.4%) available for follow up.
- result During follow up (mean, 22.4 months) four patients (28.5%) had a single recurrent episode; abscess in three (managed conservatively in two and surgically in one) and fistula-in-ano in one patient that healed spontaneously.
Pediatr Int · PMID 31469939 · Read it on PubMed ↗
Chen et al. 2019
[Application of closed negative pressure irrigation and suction device in the treatment of high perianal abscess]
Fewer fistulas with suction deviceRandomised trialModerate quality
80 people12 to 36 (24±5) months
Anal fistula formed in 2.5% of patients treated with the negative pressure device versus 17.5% treated with conventional drainage, a significant difference; one-time cure rate was also higher with the device (92.5% vs 62.5%).
Who was studied
Adults aged 18 and older with a first-time high perianal abscess
What they received
Closed negative pressure irrigation and suction device placed in the abscess cavity after drainage
Compared with
Conventional incision and drainage with gauze packing and regular dressing changes
Main outcome
Rate of anal fistula forming after treatment (along with abscess recurrence and cure rate)
Quality
It was a randomized trial with reasonable follow-up, but came from a single center with modest numbers and surgeons could not be blinded to which drainage method was used.
Limitations
Single-center study, relatively small group sizes (40 per arm), and surgery/dressing method could not be blinded to patients or clinicians.
Taken word for word from the abstract
- population ≥18-year-old patients with primary high perianal abscess who were treated at our department were prospectively enrolled
- intervention a closed negative pressure irrigation and suction device was installed and the pressure of -200 to -100 mmHg (1 mmHg=0.133 kPa) was maintained to keep the abscess cavity collapsed
- comparator conventional incision and drainage was carried out. The skin was cut at a diameter of 8 to 10 cm at the site of abscess with most obvious fluctuation. After the abscess was removed, normal saline gauze was used for dressing.
- primaryOutcome recurrence rate of perianal abscess, anal fistula formation rate were observed
- result anal fistula formation rate in negative pressure irrigation and suction group were lower than those in conventional drainage group [5.0% (2/40) vs. 20.0% (8/40), χ2=4.114, P=0.042 and 2.5% (1/40) vs. 17.5% (7/40), χ2=5.000, P=0.025, respectirely]
- n There were both 40 patients in the negative pressure irrigation and suction group and the conventional drainage group.
- followUp During follow-up of 12 to 36 (24±5) months
Zhonghua Wei Chang Wai Ke Za Zhi · PMID 31054551 · Read it on PubMed ↗
Schiano di Visconte et al. 2019
A mini-invasive procedure for the treatment of supralevator abscess of cryptoglandular origin by extrasphincteric extension: preliminary results at 1-year follow-up
High healing rate with new techniqueRetrospectiveVery low qualityRelated question
9 people1-year follow-up
5 of 9 patients had a co-existing fistula and got a seton; 1 patient needed repeat surgery; wounds healed completely after a median of 30 days; at 1 year the healing rate was 89%
Who was studied
adults with a supralevator abscess caused by a gland infection extending outside the anal sphincter
What they received
a two-step procedure: a radiologist placed a guidewire into the abscess under CT guidance, then a surgeon drained the abscess around the guidewire and removed dead tissue; a seton was placed if a complex fistula was found
Main outcome
complete wound healing and fistula recurrence at 1 year
Quality
this was a small retrospective case series of only 9 patients with no comparison group, so it cannot show whether this procedure prevents fistulas better than other approaches.
Limitations
retrospective design, very small sample (n=9), no control or comparison group, short follow-up, and the population is a specific uncommon abscess type rather than typical perianal abscess patients.
Taken word for word from the abstract
- n Nine patients, comprising 5 men (55%) and 4 women (45%), underwent the above-mentioned two-stage procedure
- population treatment of supralevator abscesses (SLA) of cryptoglandular origin by extrasphincteric extension
- intervention the interventional radiologist positioned a CT-guided percutaneous perianal guidewire inside the abscess cavity under local anesthesia. As second step, the surgeon performed an abscess incision and drainage around the guidewire, with a complete debridement of all the necrotic tissue. If a complex anal fistula was identified, a loose seton was placed in situ.
- primaryOutcome The complete wound healing was achieved after a median of 30 days (range, 26-38). At the 1-year follow-up, the healing rate was 89%.
- result A silicone draining seton was placed during the surgical procedure in 5 patients (55%), since a coexisting fistula was also revealed by surgery. A repeat surgery, along with a new drainage procedure, was required in one patient out of nine (11.1%) for a complete wound healing. The complete wound healing was achieved after a median of 30 days (range, 26-38). At the 1-year follow-up, the healing rate was 89%.
Int J Colorectal Dis · PMID 30645671 · Read it on PubMed ↗
Gong et al. 2018
Treatment of First-Time Perianal Abscess in Childhood, Balance Recurrence and Fistula Formation Rate with Medical Intervention
Conservative care had fewer fistulas than surgery.RetrospectiveLow quality
697 people395 days (median; range 120-760 days)
Conservative treatment led to a lower recurrence/fistula rate (12.7%) than incision and drainage (24.6%); abscesses that burst on their own also had a lower rate (10.9%) than incision and drainage, with no meaningful difference in how long treatment took
Who was studied
infants and young children with a first-time perianal abscess
What they received
conservative (non-surgical) treatment of the abscess
Compared with
incision and drainage surgery
Main outcome
rate of recurrence and/or fistula formation
Quality
This was a retrospective chart review, not a randomized trial, so children who got surgery may have had worse abscesses to begin with, making the comparison unreliable.
Limitations
Retrospective design with no randomization, so treatment groups may differ in abscess severity; follow-up time varied widely between patients.
Taken word for word from the abstract
- population 697 patients with first-time perianal abscess
- intervention 355 (50.9%) patients who received conservative treatment
- comparator incision and drainage (ID)
- primaryOutcome recurrences and/or development of fistula-in-ano (RF) rates
- result 12.7% (45/355) RF rate, which is less than that of abscesses treated with ID (24.6%, 72/297; p < 0.001)
- result 10.9% (5/46) RF rate, which was less than that of abscesses with ID (p = 0.019)
- n A total of 697 patients with first-time perianal abscess were included in this study.
Eur J Pediatr Surg · PMID 28564707 · Read it on PubMed ↗
Ommer et al. 2017
German S3 guidelines: anal abscess and fistula (second revised version)
Thorough drainage lowers fistula riskGuidelineLow quality
size not given2017
The guideline states that fistula/abscess recurrence risk is low overall but may result from insufficient drainage; it recommends thorough drainage while preserving sphincter muscles, reserving primary fistulotomy for superficial fistulas and performed only by experienced surgeons, with repair of unclear or high fistulas deferred to a second procedure.
Who was studied
Adults with anal/perianal abscess, often young men
What they received
Thorough drainage of the abscess, with primary fistulotomy only for superficial fistulas done by experienced surgeons
Compared with
Insufficient drainage or fistulotomy performed on complex/high fistulas by less experienced surgeons
Main outcome
Risk of abscess recurrence or secondary fistula formation
Quality
This is a consensus guideline summarizing existing literature rather than a new study, with no original patient numbers or outcome data reported.
Limitations
No specific study population size, outcome data, or statistical results are given; recommendations are based on expert synthesis of prior literature rather than new trial data.
Taken word for word from the abstract
- population the condition is most common in young men
- intervention The goal of surgery for an abscess is thorough drainage of the focus of infection while preserving the sphincter muscles.
- intervention Primary fistulotomy should only be performed in case of superficial fistulas.
- comparator However, they may result from insufficient drainage.
- primaryOutcome The risk of abscess recurrence or secondary fistula formation is low overall.
- result In case of unclear findings or high fistulas, repair should take place in a second procedure.
- result Moreover, it should be done by experienced surgeons.
Langenbecks Arch Surg · PMID 28251361 · Read it on PubMed ↗
Shtyrkova et al. 2016
[Perianal infection in patients with hemoblastosis: Risk factors and possibilities of prevention]
Surgery cut infection recurrence in cancer patients.Prospective cohortLow qualityRelated question
72 people2016
Patients who had surgery for anal fissures/fistulas had a 5 times lower risk of perianal complications during ongoing chemotherapy than those treated medically only
Who was studied
Adults with blood cancers (leukemia or lymphoma) who developed perianal infections, often during chemotherapy
What they received
Surgical treatment of anal fissures and fistulas between chemotherapy cycles, combined with antimicrobial therapy
Compared with
Medical treatment alone (antibiotics) without surgery for anal canal disease
Main outcome
Risk of perianal infection complications and recurrence of infection during continued chemotherapy
Quality
This is a small observational study in a very specific group of cancer patients undergoing chemotherapy, not in the general population having abscess drainage, so it says little about preventing fistulas in typical patients.
Limitations
Single-center prospective study in immunocompromised hematology patients, no randomization, and focused on infection/sepsis prevention during chemotherapy rather than fistula prevention after simple abscess drainage.
Taken word for word from the abstract
- population The prospective study enrolled 72 patients (37 men and 35 women; mean age, 47 years) with hemoblastosis that was complicated by the development of one of the following forms of PI: abscess, infiltrate, multiple ulcers.
- intervention 29 patients were operated on for anal fissures and fistulas at intercycle intervals.
- comparator parenteral antimicrobial therapy proved to be effective in 36 (78%) patients
- primaryOutcome to identify poor prognostic factors for perianal infection (PI) in patients with hemoblastosis and to define an effective tactic for preventive and therapeutic measures
- result In the operated versus medically treated patients, the risk of complications associated with abnormalities in the perianal area during continued CT was 5 times statistically significantly lower (odds ratio=0.2; 95% confidence interval 0.1 to 0.5; p=0.04; Cochran-Mantel test).
- n The prospective study enrolled 72 patients (37 men and 35 women; mean age, 47 years)
Ter Arkh · PMID 27459618 · Read it on PubMed ↗
Xu et al. 2016
Bacteriological study in perianal abscess is not useful and not cost-effective
Bacterial testing didn't predict fistula risk.RetrospectiveLow qualityRelated question
164 people1450 (14-2391) days
no significant link was found between the type of bacteria grown from the abscess and later development of a fistula or recurrence of the abscess
Who was studied
adults with a perianal abscess who had surgical drainage, excluding those with known anal fistula, Crohn's disease or previous perianal surgery
Main outcome
whether the abscess later developed into an anal fistula or came back
Quality
this is a retrospective single-centre study looking at bacterial culture results rather than testing a prevention method, so it can only weakly inform decisions about preventing fistula formation.
Limitations
retrospective design, and the study examines whether bacteriology predicts outcomes rather than testing any specific preventive procedure like fistulotomy, seton placement, antibiotics, or wound packing
Taken word for word from the abstract
- population A total of 164 patients, median age of 42.0 years (range 8-87) comprising of 78.7% males formed the study group.
- population Patients with known underlying anal fistula, Crohn's disease or previous perianal operations were excluded.
- n A total of 164 patients
- primaryOutcome Twenty-nine (17.7%) patients developed anal fistula and 34 (20.7%) patients had a recurrence of the perianal abscess.
- result There was no significant association between the presence of gut organism and development of fistulas (odds ratio = 0.48; 95% confidence interval = 0.17-1.37) or recurrence of perianal abscess (odds ratio = 1.66; 95% confidence interval = 0.46-6.01).
- result Bacteriological culture in perianal abscess is not useful for predicting the development of anal fistula or abscess recurrence.
ANZ J Surg · PMID 27226422 · Read it on PubMed ↗
Wright 2016
Infectious Diseases Perspective of Anorectal Abscess and Fistula-in-ano Disease
Antibiotics add no clear benefit for most patientsNarrative reviewLow qualityRelated question
size not given2016
adding antibiotics to surgery did not improve healing time or reduce recurrence in typical cases; it may help only patients with serious comorbidities, spreading infection, or whole-body infection signs
Who was studied
adults with anorectal abscess or fistula-in-ano, mostly from common gland infections
What they received
adding antibiotics to surgical incision and drainage
Compared with
surgical incision and drainage alone
Main outcome
healing time and recurrence of fistula after treatment
Quality
this is a narrative literature review combining mixed study types with the authors themselves noting the supporting data are limited
Limitations
the abstract says antibiotic conclusions are 'based on limited data' and the review draws on a mix of prospective trials, retrospective trials and case series rather than controlled comparisons of fistula-prevention techniques
Taken word for word from the abstract
- population Most patients are diagnosed with cryptoglandular disease
- intervention The use of antimicrobial therapy in combination with surgical incision and drainage
- comparator surgical incision and drainage in the treatment of cryptoglandular disease
- primaryOutcome failed to improved healing times or reduce recurrences or both
- result The use of antimicrobial therapy in combination with surgical incision and drainage in the treatment of cryptoglandular disease has failed to improved healing times or reduce recurrences or both. Based on limited data, routine antimicrobial therapy may benefit patients with significant comorbid conditions, extensive cellulitis and systemic symptoms.
Am J Med Sci · PMID 27079352 · Read it on PubMed ↗
Pearce et al. 2016
Multicentre observational study of outcomes after drainage of acute perianal abscess
One in four developed fistula; packing didn't help.Prospective cohortLow qualityRelated question
141 people6 months
Despite routine wound packing, 26.7 per cent of patients developed a fistula in ano by 6 months following surgery, and packing caused repeated pain without demonstrated benefit
Who was studied
adults with an acute perianal abscess after surgical drainage
What they received
wound packing (dressing changes) after abscess drainage
Main outcome
rate of fistula formation after abscess drainage
Quality
This was a descriptive, multicentre observational study of standard practice with no comparison group, so it cannot show whether any specific measure prevents fistula formation.
Limitations
No control group or comparison between different management strategies (e.g. packing vs no packing, or primary fistulotomy/seton); purely observational of current practice.
Taken word for word from the abstract
- population Some 141 patients were recruited (median age 39 (range 18-86) years).
- intervention The evidence for postoperative wound packing is limited and may expose patients to painful procedures with no clinical benefit and at considerable increased cost.
- primaryOutcome Outcome measures included number of dressing (pack) changes, healing, recurrence, return to work/normal function, postoperative fistula in ano and health utility scores (EQ-5D™).
- result 26·7 per cent of patients developed a fistula in ano by 6 months following surgery.
- result Packing is painful and costly.
- n Some 141 patients were recruited (median age 39 (range 18-86) years).
Br J Surg · PMID 27061287 · Read it on PubMed ↗
Garcia-Granero et al. 2014
Management of cryptoglandular supralevator abscesses in the magnetic resonance imaging era: a case series
Treating fistula after drainage prevented recurrenceCase seriesVery low qualityRelated question
13 peoplemedian 61 months
Recurrence of sepsis happened only in patients whose abscess had an ischiorectal origin and who did not have the fistula treated afterward; patients who had seton or flap treatment did not recur
Who was studied
Adults with a supralevator abscess (a deep type of anal abscess) caused by gland infection
What they received
Treating the fistula after abscess drainage (using seton placement or advancement flap, guided by MRI-identified abscess origin)
Compared with
Abscess drainage alone without subsequent fistula treatment
Main outcome
Long-term recurrence of anal sepsis/fistula
Quality
This is a very small retrospective case series of only 13 patients from one center, so the findings could easily be due to chance or selection rather than the treatment itself.
Limitations
Retrospective design, very small sample size, specific to a rare abscess subtype (supralevator), no control group, no randomization or statistical testing reported
Taken word for word from the abstract
- population thirteen consecutive patients with cryptoglandular supralevator abscess treated between 2001 and 2011
- intervention Four patients underwent secondary treatment of anal fistula: two rectal advancement flap and two non-cutting seton
- comparator only patients with supralevator abscess of ischiorectal origin in whom fistula was not subsequently treated presented a recurrence of the anal sepsis
- primaryOutcome Short- and long-term results after drainage were also evaluated
- result In the long-term follow-up (median 61 months), only patients with supralevator abscess of ischiorectal origin in whom fistula was not subsequently treated presented a recurrence of the anal sepsis
- n A retrospective case series including thirteen consecutive patients
- followUp median 61 months
Int J Colorectal Dis · PMID 25339133 · Read it on PubMed ↗
Zubaidi 2014
Anal fistula. Past and present
No prevention data reported.Narrative reviewLow qualityRelated question
size not given2014
This is a general review of anal fistula management (imaging and treatment of existing fistulas), and does not address methods to prevent a fistula from forming after an abscess.
Who was studied
people with anal fistula
Quality
It is a narrative review describing treatment options for established fistulas, not a study testing prevention strategies, so it cannot answer this question.
Limitations
No methodology described, no data on abscess patients or prevention measures, and no outcome data reported.
Taken word for word from the abstract
- population Anal fistula is a common benign condition that typically describes a miscommunication between the anorectum and the perianal skin, which may present de novo, or develop after acute anorectal abscess.
- result The goal of this review is to ensure surgeons and physicians are aware of the different imaging and treatment choices available, and to report expected outcomes of the various surgical modalities so they may select the most suitable treatment.
Saudi Med J · PMID 25228174 · Read it on PubMed ↗
Bakari et al. 2013
Fistula-in-Ano Complicated by Fournier's Gangrene Our Experience in North-Eastern Region of Nigeria
Describes gangrene cases, not fistula prevention.Case seriesVery low qualityRelated question
10 people2013
This is a retrospective case series describing how 10 men with fistula-in-ano that progressed to Fournier's gangrene were treated; it does not test or compare methods for preventing fistula formation after an abscess. The authors state that early antibiotics and primary surgical treatment of the abscess can prevent Fournier's gangrene, but this is a conclusion/opinion, not a tested comparison of prevention strategies.
Who was studied
men with fistula-in-ano that had become complicated by Fournier's gangrene
What they received
various surgical treatments for existing fistula-in-ano and Fournier's gangrene (fistulotomy, seton, mucosal advancement flap, sitz baths)
Main outcome
management and outcomes of fistula-in-ano complicated by Fournier's gangrene
Quality
Small retrospective case series of only 10 patients with no comparison group, so it cannot show whether any approach actually prevents fistula or its complications.
Limitations
Retrospective chart review, very small sample, no control group, and the population already had fistula-in-ano (some complicated by gangrene) rather than being studied at the point of abscess drainage to test fistula-prevention strategies.
Taken word for word from the abstract
- population A total of 10 men with a mean age of 50.5 years (35-60) were managed in the period of study.
- n A total of 10 men with a mean age of 50.5 years (35-60) were managed in the period of study.
- intervention Mucosal advancement flap was performed in 5 (50%) and fistulotomy in 3 (30%) patients.
- primaryOutcome These were analyzed for demographic, clinical and pathological variables, the type of treatment and follow-up.
- result Early broad spectrum parenteral antibiotic therapy and primary surgical treatment can prevent Fournier's gangrene.
Niger J Surg · PMID 24497752 · Read it on PubMed ↗
Inoue et al. 2014
Long-term results of seton placement for fistula-in-ano in infants
Seton treated existing fistulas wellRetrospectiveLow qualityRelated question
90 people49.8 ± 11.4 months
35 of 36 infants (97.2%) healed after the first seton procedure; the one recurrence healed after a second seton placement
Who was studied
infants under 1 year old who had a perianal abscess, some of whom went on to develop a fistula
What they received
seton placement (a cutting seton) to treat fistula-in-ano once it had already formed
Main outcome
whether the fistula healed after seton placement
Quality
this is a retrospective, single-arm review of one treatment with no comparison group, so it cannot show whether anything prevents fistulas from forming in the first place
Limitations
retrospective design, no comparison group, and the study treats fistulas that had already formed rather than testing ways to prevent fistula formation at the time of abscess drainage
Taken word for word from the abstract
- population Data of patients aged <1 year who presented to our department with perianal abscess (PA) between January 2006 and February 2010 were retrospectively reviewed.
- intervention 36 (40%) developed FIA (39 lesions) and underwent seton placement
- primaryOutcome The condition healed in a mean period of 6.3 ± 4.0 weeks after the placement of a cutting seton.
- result Healing of the fistula was achieved in 35 (97.2%) of 36 patients after the initial seton procedure, and one patient who showed recurrence underwent a second seton placement, resulting in successful healing of the FIA after 5 weeks.
- n Ninety-five patients were treated for PA and/or FIA during the 5-year period, and follow-up data were available for 90 patients.
J Gastrointest Surg · PMID 24065365 · Read it on PubMed ↗
Charalampopoulos et al. 2012
Surgical treatment of perianal abscess and fistula-in-ano in childhood, with emphasis in children older than 2 years
Low fistula rate after drainage.RetrospectiveLow qualityRelated question
98 people2012
After incision and drainage of abscess, recurrence or fistula formation occurred in 13% of patients; fistulotomy succeeded in most fistula patients, and complex fistulas requiring seton placement were uncommon (6%)
Who was studied
children older than 2 years with a perianal abscess or fistula-in-ano, otherwise healthy with no risk factors for anal sepsis
What they received
incision and drainage for abscess, with fistulotomy (sometimes plus seton or cryptotomy) for fistula-in-ano
Main outcome
recurrence of sepsis or fistula formation after treatment
Quality
This is a retrospective, uncontrolled review of one surgical team's outcomes in children, with no comparison between different preventive approaches.
Limitations
No comparison group between different prevention strategies (e.g., seton vs no seton, antibiotics vs none); single-center pediatric series; outcomes reported as overall surgical results rather than a test of a specific preventive technique.
Taken word for word from the abstract
- population anal sepsis in older children presents significant similarities to that of adults
- population All patients were healthy without risk factors for anal sepsis.
- n Ninety-eight (98) children were operated on for anal abscess (46 patients; 47%) and/or fistula-in-ano (52 patients; 53%).
- intervention Incision and drainage of the abscess was performed as outpatients. In patients with fistulas, fistulotomy was the main treatment approach.
- primaryOutcome low recurrence (13%) or fistula formation rates were observed
- result In patients with anal abscess treated with incision and drainage, low recurrence (13%) or fistula formation rates were observed.
- result Fistulotomy was performed in all patients with additional seton placement in 3 (6%) of 52 and a cryptotomy in 5 (10%) of 52 patients.
J Pediatr Surg · PMID 23164005 · Read it on PubMed ↗
Afşarlar et al. 2011
Perianal abscess and fistula-in-ano in children: clinical characteristic, management and outcome
Antibiotics lowered fistula risk; drainage type didn't matterRetrospectiveLow quality
158 people10.6 ± 8.6 months
Antibiotic use significantly reduced development of fistula-in-ano, but the drainage method (incision and drainage vs spontaneous drainage) made no significant difference in abscess recurrence or fistula formation
Who was studied
children with perianal abscess and fistula-in-ano
What they received
incision and drainage, spontaneous drainage, and antibiotic therapy after abscess treatment
Compared with
different drainage methods (incision and drainage vs spontaneous drainage) and antibiotic use vs no antibiotic use
Main outcome
development of fistula-in-ano after abscess treatment
Quality
This is a retrospective chart review without randomization, so differences between groups could be due to other factors rather than the treatments themselves.
Limitations
Retrospective design, no randomization, patients with systemic or inflammatory bowel disease excluded, relatively short mean follow-up
Taken word for word from the abstract
- n A total of 158 children (146 males, 12 females) treated for perianal abscess and fistula-in-ano
- population A retrospective review of children with perianal abscess and fistula-in-ano was carried out in a tertiary care children's hospital
- intervention Primary treatment was incision and drainage (I/D) for the fluctuating perianal abscess (73.5%), and local care for the spontaneously (S/D) drained abscess (26.5%) with or without antibiotic therapy
- comparator Recurrence rates (27% in I/D and 30.6% in S/D, p > 0.05) and development of fistula-in-ano (20% in I/D and 27.8 in S/D, p > 0.05) were not significant I/D and S/D groups
- primaryOutcome development of fistula-in-ano
- result Usage of antibiotics significantly reduced the development of fistula-in-ano (p = 0.001), but did not effect the recurrence of perianal abscess (p > 0.05)
Pediatr Surg Int · PMID 21785979 · Read it on PubMed ↗
Kubota et al. 2010
Usefulness of bFGF spray in the treatment of perianal abscess and fistula-in-ano
Abscesses healed, no lasting fistula recurrence.Case seriesVery low qualityRelated question
9 peoplemean follow-up period of 14.1 ± 3.2 months
All nine infants improved, with pus and swelling resolving in about a week; two had a relapse or new lesion later but these healed after a second bFGF treatment, and no recurrences were seen at follow-up averaging about 14 months
Who was studied
infant boys (average age 5 months) with perianal abscess
What they received
bFGF (basic fibroblast growth factor) spray applied to the abscess twice daily
Compared with
none; no comparison group
Main outcome
resolution of abscess/fistula symptoms and recurrence after treatment
Quality
This is a very small, uncontrolled case series of only nine infants with no comparison group, so it cannot show whether bFGF actually prevents fistula formation better than other care.
Limitations
No control group, very small sample, population is infants rather than the general adult/child population with anorectal abscess, and the intervention (bFGF spray) is not one of the standard prevention approaches (fistulotomy, seton, antibiotics, packing) being compared.
Taken word for word from the abstract
- n Nine consecutive males with an average age of 5.1 months (1-9 months)
- population Nine consecutive males with an average age of 5.1 months (1-9 months) who presented with perianal abscess
- intervention Two or three sprays of bFGF were applied to the perianal abscess two times a day.
- comparator treated with bFGF (Transfermin, Kaken Co., Ltd., Tokyo, Japan)
- primaryOutcome Pus discharge and local swelling around the fistula subsided within a mean of 7.3 ± 1.9 days
- result The remaining seven cases have all done well without any recurrence at a mean follow-up period of 14.1 ± 3.2 months.
Pediatr Surg Int · PMID 20632016 · Read it on PubMed ↗
Stremitzer et al. 2011
Treatment of perianal sepsis and long-term outcome of recurrence and continence
High recurrence, incontinence risk rises with more surgeryRetrospectiveLow quality
173 people121 (77-171) months
Most patients needed more than one surgical procedure to resolve their perianal sepsis; the more extensive the surgery (simple drainage, drainage plus fistulotomy, or multiple procedures), the higher the rate of fecal incontinence, with no incontinence after drainage alone, some incontinence after fistulotomy, and similar rates after multiple procedures
Who was studied
Adults with perianal abscess (perianal sepsis of cryptoglandular origin) treated between 1994 and 2000
Main outcome
Recurrence of perianal sepsis and fecal incontinence after treatment
Quality
This is a retrospective chart review with only 58% long-term follow-up and no randomization between treatment approaches, so differences between groups could reflect how severe each patient's disease was rather than the treatment itself.
Limitations
Retrospective design, 42% lost to follow-up, no control for confounding between treatment groups, reliance on chart review and later telephone questionnaire
Taken word for word from the abstract
- n One hundred seventy-three (58%) of 300 patients were available for follow-up
- population patients with perianal sepsis of cryptoglandular origin
- primaryOutcome regarding recurrence and faecal incontinence
- result After a single surgical procedure, 55 (32%) patients had no recurrence of perianal sepsis. In 118 (68%), recurrence required multiple procedures (median 3, range 2-19). If only a single incision and drainage was performed (n = 10, 6%), no faecal incontinence occurred. Drainage with fistulotomy (n = 45, 26%) induced mild incontinence in 9% and severe incontinence in 4%. After multiple procedures that were required in 118 (68%) patients, mild and severe faecal incontinence was found in 16% and 4% of them, respectively.
- followUp median period of 121 (77-171) months
Colorectal Dis · PMID 20236152 · Read it on PubMed ↗
Ezer et al. 2010
Perianal abscess and fistula-in-ano in children: aetiology, management and outcome
High fistula rate after abscess treatmentRetrospectiveLow qualityRelated question
39 people2010
a high rate (85%) of fistula formation occurred after treatment of perianal abscess either with incision and drainage (with or without antibiotics) or with antibiotics alone
Who was studied
children treated for perianal abscess and/or fistula-in-ano
Main outcome
whether a fistula formed after treatment of a perianal abscess
Quality
This is a small retrospective series of 39 children with no comparison group, so it cannot tell which approach actually prevents fistula formation.
Limitations
Retrospective chart review, small sample, no direct comparison between prevention techniques such as seton placement or primary fistulotomy, some patients lost to follow-up.
Taken word for word from the abstract
- population The patients who were treated for perianal abscess and/or fistula-in-ano from January 2000 to December 2005 were included.
- n The study consisted of 39 patients (36 boys)
- primaryOutcome Of 20 patients with perianal abscess, 17 developed fistula-in-ano and three healed.
- result Treatment of a perianal abscess either through incision and drainage with antibiotics or through antibiotics alone resulted in a high rate (85%) of fistula formation.
J Paediatr Child Health · PMID 20105258 · Read it on PubMed ↗
Lin 2009
[Tunnel thread-drawing therapy in treating patients with horseshoe-shaped low-position perianal abscess: a randomized controlled trial]
Faster healing, no difference in recurrenceRandomised trialLow qualityRelated question
68 peoplehalf a year to three years
Thread-drawing therapy led to shorter pain duration and faster wound healing than multiple incisions and drainage, but recurrence rates were not significantly different between the two groups
Who was studied
Adults with a horseshoe-shaped, low-position perianal abscess treated at a single hospital's anorectal surgery department
What they received
Tunnel thread-drawing therapy (a thread-based drainage technique)
Compared with
Multiple incisions and drainage
Main outcome
Duration of postoperative pain, time for the wound to heal, size of the resulting scar, anal function, and recurrence after surgery
Quality
This was a small, single-center trial with no description of blinding or allocation concealment, which limits how much confidence can be placed in the findings.
Limitations
Small sample size (68 patients), single center, no mention of blinding, and follow-up duration varied widely (6 months to 3 years) across patients.
Taken word for word from the abstract
- population A total of 68 patients with horseshoe-shaped low-position perianal abscess were from Department of Anorectal Surgery, Shanghai Tianshan Traditional Chinese Medicine Hospital, and were randomly divided into treatment group and control group.
- intervention The patients in the treatment group received thread-drawing therapy
- comparator the patients in the control group received multiple incisions and drainage
- primaryOutcome Lasting time of postoperative pain, healing time of incision, average area of the wound scar, anal function and postoperative recurrence were observed in the two groups.
- result The lasting time of postoperative pain and healing time of incision in the treatment group were shortened as compared with those in the control group (P<0.01). There was no significant difference in postoperative recurrence rate between the two groups (P>0.05).
- n A total of 68 patients with horseshoe-shaped low-position perianal abscess were from Department of Anorectal Surgery, Shanghai Tianshan Traditional Chinese Medicine Hospital, and were randomly divided into treatment group and control group.
Zhong Xi Yi Jie He Xue Bao · PMID 20015430 · Read it on PubMed ↗
Niyogi et al. 2010
Management of perianal abscess and fistula-in-ano in children
Early surgery lowered recurrence in young childrenRetrospectiveLow qualityRelated question
78 people6 months (range 8 weeks-3 years)
Recurrence after initial surgery was higher in children under 2 and over 8 years than in those aged 2-8; surgery in children under 2 gave the lowest recurrence rate, while fistulas (identified at first surgery or on recurrence) were most common in children over 8; topical tacrolimus worked well for Crohn's-related fistulas
Who was studied
Children under 16 years old treated for a perianal abscess or anal fistula
What they received
Different treatments by age group: incision and drainage, fistulotomy, selective probing for fistula, and topical tacrolimus for Crohn's-related fistulas
Compared with
Comparison across three age groups (under 2, 2-8, and over 8 years) and across treatment types
Main outcome
Recurrence of abscess or fistula after treatment
Quality
This was a small retrospective chart review without a control group comparing preventive approaches directly, so it cannot reliably show which approach prevents fistula formation.
Limitations
Retrospective design, small subgroup sizes, no direct comparison of specific fistula-prevention techniques (such as seton placement or antibiotics), and findings specific to children rather than adults.
Taken word for word from the abstract
- population A retrospective study was conducted of children below 16 years of age treated for PA/FIA in a pediatric surgery center between January 2002 and April 2006.
- intervention The standard treatment for PA was incision and drainage (I&D). Judicious probing for fistulae was only performed in recurrent abscess or if a discharge of pus was identified from the anal verge at surgery. Fistulotomy was routinely performed in low fistulae not associated with inflammatory bowel disease (IBD). IBD associated fistulae were treated with topical tacrolimus
- comparator Patients were divided into 3 age groups: <2 years, 2-8 years and >8 years.
- primaryOutcome Mode of treatment, microbial organisms, recurrence, associated FIA and association with IBD were recorded.
- result The recurrence rate after primary surgery was significantly higher for <2 years and >8 years age groups compared to the 2-8 years age group.
- result The incidence of FIA identified either at primary operation or during exploration for recurrence was highest (50%) in >8 years age group and lowest (21%) in the <2 years age group.
- result Six of 7 patients with IBD associated FIA were treated successfully with topical tacrolimus.
- n A total of 78 (39 [<2 years]; 17 [2-8 years]; 22 [>8 years]) patients were treated for PA/FIA during the four year period.
Eur J Pediatr Surg · PMID 19899037 · Read it on PubMed ↗
Hamadani et al. 2009
Who is at risk for developing chronic anal fistula or recurrent anal sepsis after initial perianal abscess?
Younger age raised fistula risk; antibiotics didn't help.RetrospectiveLow qualityRelated question
148 people38 months
Age under 40 was linked to more than double the risk of recurrence; diabetics had lower risk than nondiabetics; perioperative antibiotics, gender, smoking, and HIV status made no significant difference to recurrence risk
Who was studied
adults with a first-time perianal abscess
Main outcome
developing chronic anal fistula or recurrent anal sepsis after initial abscess treatment
Quality
This is a retrospective single-center cohort study that looked at risk factors rather than testing a preventive treatment, so it cannot show whether any intervention actually prevents fistula formation.
Limitations
Retrospective design, single institution, no randomization or controlled comparison of specific preventive interventions like fistulotomy, seton placement, or wound packing.
Taken word for word from the abstract
- population patients with a first-time perianal abscess who were treated at Kaiser Permanente Los Angeles between 1995 and 2007
- n One hundred and forty-eight patients met inclusion criteria
- primaryOutcome to determine factors that contribute to chronic anal fistula or recurrent sepsis after initial perianal abscess
- result Univariate and multivariable analyses showed more than two-fold increased risk of recurrence in patients <40 years vs. those >/=40 years (P < 0.01), and univariate analysis showed nondiabetics were 2.69 times as likely to experience recurrence as diabetics (P = 0.04).
- result perioperative antibiotics vs. no antibiotics (HR = 1.51; P = 0.19)
- result Gender, smoking history, perioperative antibiotic treatment, and HIV status were not risk factors for chronic anal fistula or recurrent anal sepsis.
Dis Colon Rectum · PMID 19279415 · Read it on PubMed ↗
Novotny et al. 2008
Fistula in ano in infants: who recurs?
13% recurrence after fistula surgeryRetrospectiveLow qualityRelated question
92 people2008
13% of children had a fistula recurrence; recurrence was more likely in those who were older, had a prior abscess, or had pus seen at the time of surgery
Who was studied
children under 3 years old who had surgery (fistulotomy) for an existing anal fistula
What they received
anal fistulotomy (surgical division of the fistula)
Main outcome
fistula recurrence after fistulotomy
Quality
This is a retrospective single-center review without a comparison group, looking at risk factors for recurrence after one treatment rather than testing ways to prevent fistula formation.
Limitations
Retrospective design, no control group, and it studies children who already have a fistula rather than prevention of fistula formation after an abscess.
Taken word for word from the abstract
- population A retrospective review of patients less than 3 years old undergoing anal fistulotomy was performed between May 2002 and November 2007 at a tertiary children's hospital.
- intervention undergoing anal fistulotomy
- n A total of 92 children undergoing anal fistulotomy were identified.
- primaryOutcome identify predictors of which children will ultimately recur
- result Twelve children (13%) had recurrences and two of the 12 had multiple recurrences. Children who had recurrences were older (12.9 vs. 7.5 months, P < 0.05) and were more likely to have a previous abscess (20 vs. 6%, P < 0.05). In addition, children with recurrences had pus noted at the time of surgery more than children who did not recur (23 vs. 8%, respectively, P < 0.05).
Pediatr Surg Int · PMID 18704449 · Read it on PubMed ↗
Whiteford et al. 2005
Practice parameters for the treatment of perianal abscess and fistula-in-ano (revised)
No findings reported here.GuidelineLow qualityRelated question
size not given2005
This is a general practice guideline statement describing the purpose and scope of the Society's recommendations; it does not report specific findings, data, or comparisons on preventing fistula formation.
Who was studied
Adults and children with an abscess or fistula around the anus
Quality
This abstract is only the preamble describing the guideline's purpose and committee process, with no actual evidence, data, or recommendations presented.
Limitations
The abstract contains no clinical data, outcomes, or comparisons relevant to fistula prevention; it only describes the guideline's intent and disclaimer.
Taken word for word from the abstract
- population disorders and diseases of the colon, rectum, and anus
- result These guidelines are inclusive, and not prescriptive. Their purpose is to provide information on which decisions can be made, rather than dictate a specific form of treatment.
Dis Colon Rectum · PMID 15933794 · Read it on PubMed ↗
Serour et al. 2005
Perianal abscess and fistula-in-ano in infants: a different entity?
Antibiotics after drainage reduced fistula risk in infants.RetrospectiveLow qualityRelated question
98 people2005
infants who got antibiotics after drainage were less likely to develop a fistula than those who had drainage alone (27.9% vs 66.7%)
Who was studied
infants younger than 24 months with perianal abscess or fistula-in-ano
What they received
antibiotics given after drainage of the abscess
Compared with
drainage alone with no antibiotics
Main outcome
development of fistula-in-ano after abscess drainage
Quality
this is a small retrospective chart review in infants, not a controlled trial, so the antibiotic comparison could be confounded by other differences between groups.
Limitations
Retrospective design, no randomization, infants only (described by authors as a different entity from older children/adults), mixed drainage methods (mostly needle aspiration, only 5 incision and drainage).
Taken word for word from the abstract
- population all infants younger than 24 months of age treated for perianal abscess, fistula-in-ano, or both from 1990 to 2002
- n The study included 98 infants.
- intervention Patients who received antibiotics following drainage
- comparator patients who underwent a drainage procedure alone
- primaryOutcome Twenty-eight boys (36.4 percent) had an evolution toward fistula-in-ano.
- result Patients who received antibiotics following drainage were less likely to develop fistula-in-ano than were patients who underwent a drainage procedure alone (27.9 percent vs. 66.7 percent, P < 0.05).
Dis Colon Rectum · PMID 15616754 · Read it on PubMed ↗
Inceoglu et al. 2003
Fistulotomy and drainage of deep postanal space abscess in the treatment of posterior horseshoe fistula
Existing fistula surgery healed well, not about preventionRetrospectiveLow qualityRelated question
25 people35 (range, 6-78) months
all patients healed with no recurrence and no complications after this surgical technique
Who was studied
adults with a complex posterior horseshoe anal fistula and deep abscess, most with prior fistula surgery
What they received
fistulotomy of the fistula tracts combined with drainage of the deep postanal space abscess
Compared with
no comparison group; single treatment approach reviewed retrospectively
Main outcome
wound healing time and recurrence of fistula
Quality
this is a small retrospective case series without a comparison group, so it cannot show whether this approach prevents fistula formation better than other options
Limitations
retrospective design, no control group, and most patients already had an established fistula-in-ano rather than a first-time abscess being treated to prevent fistula formation
Taken word for word from the abstract
- population Posterior horseshoe fistula with deep postanal space abscess is a complex disease. Most patients have a history of anorectal abscess drainage or surgery for fistula-in-ano.
- n Twenty-five patients who underwent surgery for posterior horseshoe fistula with deep postanal space abscess were analyzed retrospectively
- intervention Fistulotomy of the tracts along the arms of horseshoe fistula and drainage of the deep postanal space abscess with posterior midline incision
- comparator Twenty-five patients who underwent surgery for posterior horseshoe fistula with deep postanal space abscess were analyzed retrospectively with respect to age, gender, previous surgery for fistula-in-ano, number of external openings, diagnostic studies, concordance between preoperative studies and operative findings for the extent of disease, operating time, healing time, complications, and recurrence.
- primaryOutcome The mean +/- SD healing time was 12 +/- 3 weeks.
- result All patients were followed up for a median of 35 (range, 6-78) months and no recurrence was observed.
BMC Surg · PMID 14641926 · Read it on PubMed ↗
Barthés-Anidjar et al. 2003
[Perianal abcess in infant]
No fistula after drainage.Case seriesVery low qualityRelated question
1 people2003
the infant had drainage of the abscess, no fistula was found during surgery, and there was no recurrence afterward
Who was studied
a 7-week-old baby boy with a perianal abscess
Main outcome
whether a fistula formed after abscess drainage
Quality
this is a single infant case report, so it cannot show which approach actually prevents fistula formation.
Limitations
single case report with no comparison group, so no approach to fistula prevention can be tested or confirmed.
Taken word for word from the abstract
- population A 7-week-old boy had a painful swollen perianal lesion suggesting the presence of perianal abcess.
- primaryOutcome During the intervention, no fistula was found.
- result During the intervention, no fistula was found. No recurrence was observed.
- n A 7-week-old boy
Ann Dermatol Venereol · PMID 12746675 · Read it on PubMed ↗
Murthi et al. 2002
Perianal abscess in childhood
Fistulotomy at drainage prevented recurrenceRetrospectiveLow quality
33 people2002
All 7 recurrences occurred in children treated by incision and drainage alone; none of the children who also had fistulotomy at the time of primary drainage had a recurrence
Who was studied
children with perianal abscess
What they received
fistulotomy (laying open of fistulous tract) performed at the time of primary incision and drainage
Compared with
incision and drainage alone
Main outcome
recurrence as fistula-in-ano or repeat abscess
Quality
This was a small retrospective chart review without randomization, so differences between groups could be due to selection rather than treatment.
Limitations
Retrospective design, small sample size, and treatment choice (fistulotomy vs drainage alone) was not randomized but depended on whether a fistula was identified at surgery.
Taken word for word from the abstract
- population Perianal abscess (PA) is a common condition encountered in childhood
- n Thirty-three cases were identified (29 boys and 4 girls).
- intervention A fistulous tract was identified and laid open at the time of primary drainage in 20 cases
- comparator 13 were treated by I & D alone
- primaryOutcome Following primary drainage, there were 7 recurrences (21.2%) (FIA 5 and PA 2).
- result All recurrences had been primarily treated by drainage alone, whilst there were no recurrences in patients who had also undergone fistulotomy at the time of primary drainage.
Pediatr Surg Int · PMID 12598965 · Read it on PubMed ↗
Muñoz-Villasmil et al. 2001
Management of perianal sepsis in immunosuppressed patients
High healing, low complications overallRetrospectiveLow qualityRelated question
83 peoplea mean of 15 months
Most wounds (91%) healed within 8 weeks, with incontinence in 6% and recurrence in 7%, similar to outcomes in non-immunosuppressed patients
Who was studied
Immunosuppressed adults with perianal abscess and/or anal fistula (HIV+, inflammatory bowel disease on steroids, malignancy, or diabetes)
What they received
Various surgical approaches for perianal sepsis: primary fistulotomy, fistulotomy plus drainage, fistulotomy plus ostomy, or fistulectomy plus drainage
Compared with
Different surgical procedures compared against each other within the same cohort, not against a no-treatment or standard-care control
Main outcome
Wound healing, incontinence, and fistula/abscess recurrence after surgery
Quality
This is a retrospective case review without a control group, mixing patients who already had fistulas with those who had abscesses only, so it cannot show which approach actually prevents fistula formation.
Limitations
Retrospective design, no control group, most patients already had an established fistula (68%) rather than abscess alone (2%), and only 66 of 83 patients had follow-up data.
Taken word for word from the abstract
- population We reviewed 83 immunocompromised patients with diagnosis of perianal sepsis from 1995 to 1997.
- n We reviewed 83 immunocompromised patients with diagnosis of perianal sepsis from 1995 to 1997.
- intervention The most commonly practiced surgical procedures were primary fistulotomy (n = 23) and fistulotomy plus drainage (n = 28). Seven patients underwent fistulotomy and ostomy and eight patients were treated with fistulectomy plus drainage.
- comparator The most commonly practiced surgical procedures were primary fistulotomy (n = 23) and fistulotomy plus drainage (n = 28).
- primaryOutcome Most wounds (91%) healed within 8 weeks. Incontinence (6%) and recurrence (7%) were the most commonly observed complications.
- result Most wounds (91%) healed within 8 weeks. Incontinence (6%) and recurrence (7%) were the most commonly observed complications. These results are similar to those seen in the general population.
Am Surg · PMID 11379655 · Read it on PubMed ↗
Knoefel et al. 2000
The initial approach to anorectal abscesses: fistulotomy is safe and reduces the chance of recurrences
Fistulotomy cut recurrence, no added risk.RetrospectiveLow quality
131 people40 (range 3-78) months
Fistulotomy at the time of drainage reduced recurrence from 34% to 4% compared with drainage alone; in patients having surgery for recurrence, simultaneous fistulotomy reduced recurrence from 67% to 0%. Incontinence of liquid stool and flatus occurred in 4 of 131 patients (3%), only after recurrent disease, with no incontinence of solid stool.
Who was studied
Adults with an anorectal abscess or anal fistula
What they received
Fistulotomy (cutting open the fistula tract) performed at the same time as draining the abscess
Compared with
Incision and drainage of the abscess alone, without fistulotomy
Main outcome
Rate of disease recurrence and development of incontinence
Quality
This was a retrospective review of records and follow-up questionnaires without randomization, so other differences between groups could explain the results.
Limitations
Retrospective design, not randomized, relies partly on follow-up questionnaires, and incontinence outcomes are based on small numbers.
Taken word for word from the abstract
- population 158 patients with an anorectal abscess or anal fistula were identified in our institution
- n The records and follow-up questionnaires of 131 patients were evaluable.
- intervention fistulotomy was performed at the time of draining the abscess
- comparator incision and drainage alone
- primaryOutcome Our aim was to determine which approach has less recurrences and carries a lower risk of continence disorders.
- result the recurrence rate could be reduced, in comparison to incision and drainage alone, from 34 to 4% (p = 0.007)
- result the recurrence rate could even be reduced from 67 to 0% (p = 0.03) by simultaneous fistulotomy
- result A total of 4 of the 131 patients (3%) developed incontinence of liquid stool and flatus, but no incontinence of solid stool occurred.
Dig Surg · PMID 10867462 · Read it on PubMed ↗
Festen et al. 1998
Perianal abscess and fistula-in-ano in infants
Fistula often follows abscess drainage in infants.RetrospectiveLow qualityRelated question
size not given1 to 24 year, mean 7.74 year
35% of abscess drainages were followed by a fistula; fistulotomy or fistulectomy was followed by recurrence in 13% of cases, with long-term recurrences being rare and no serious long-term disability
Who was studied
infants treated for perianal abscess and fistula-in-ano at a pediatric surgical center
What they received
drainage of a perianal abscess, sometimes followed by fistulotomy or fistulectomy for a fistula
Main outcome
whether a fistula formed after abscess drainage, and whether the fistula recurred after surgery
Quality
This is a retrospective chart review without a comparison group of different prevention strategies, so it can only describe outcomes, not show which approach prevents fistula best.
Limitations
Retrospective design, no comparison between different prevention approaches (e.g., primary fistulotomy vs simple drainage), and the population is limited to infants.
Taken word for word from the abstract
- population Perianal abscess and fistula-in-ano in infants
- intervention Drainage of a perianal abscess is followed in 35% of cases by a fistula. Fistulotomy or fistulectomy is followed in 13% of cases by a recurrence.
- primaryOutcome to obtain insight into the short- and long-term results of treatment of perianal abscess and fistula-in-ano in infants
- result Drainage of a perianal abscess is followed in 35% of cases by a fistula. Fistulotomy or fistulectomy is followed in 13% of cases by a recurrence.
- followUp 1 to 24 year, mean 7.74 year
J Pediatr Surg · PMID 9607474 · Read it on PubMed ↗
Cox et al. 1997
Outcome after incision and drainage with fistulotomy for ischiorectal abscess
Fistulotomy at drainage lowered recurrence.RetrospectiveLow quality
80 peoplemean, 44.3 months
Recurrence was lower when fistulotomy was done at the same time as drainage (21.1%) compared with drainage alone (44%), with a similar rate of continence change (15.8% vs 11.8%)
Who was studied
adults with ischiorectal (perianal) abscess
What they received
incision and drainage plus fistulotomy (or seton placement) at the time of initial surgery
Compared with
incision and drainage alone
Main outcome
recurrence rate and change in anal continence after surgery
Quality
This is a single-center retrospective chart review without randomization, so differences between groups could be due to patient selection rather than the treatment itself.
Limitations
Retrospective design, no randomization, follow-up partly by telephone interview, and treatment choice (I&D alone vs I&D with fistulotomy) was not standardized.
Taken word for word from the abstract
- population 80 patients with IA managed from 1983 to 1996
- intervention Drainage is followed by a careful examination of the anal canal for fistula localization followed by fistulotomy, or less frequently by cutting seton placement.
- comparator 34 (42.5%) I&D alone
- primaryOutcome evaluation of recurrence rates and anal continence
- result Results showed a 44 per cent recurrence rate in those who underwent I&D as compared with 21.1 per cent following I&D and F.
- result 11.8 per cent of patients treated with I&D experienced a change in their level of continence postoperatively as compared to 15.8 per cent treated with I&D and F.
- n retrospective review of 80 patients with IA
- followUp Follow-up data were available on 99 per cent of patients; mean, 44.3 months.
Am Surg · PMID 9247434 · Read it on PubMed ↗
Nix et al. 1997
Perianal sepsis in children
Few fistulas after drainage; fistulectomy fewer recurrencesRetrospectiveLow quality
58 people1997
only four of 38 children treated for an abscess developed a fistula, and fistula formation only occurred in those with enteric bacterial infection; of 24 children with a fistula, five needed further surgery for recurrence, four of whom were first treated by fistulotomy, and fistulectomy resulted in significantly fewer recurrences
Who was studied
children with a perianal abscess or fistula
What they received
treatment of the abscess by incision and drainage, with some children later undergoing fistulotomy or fistulectomy for fistula
Compared with
fistulotomy versus fistulectomy for children who developed a fistula
Main outcome
fistula formation after abscess treatment and recurrence after fistula surgery
Quality
this is a small retrospective review of children from one centre without randomisation, so the comparison between fistulotomy and fistulectomy could be biased by how cases were selected.
Limitations
retrospective, single-centre, small numbers of children who developed a fistula, no randomised comparison of treatments
Taken word for word from the abstract
- population 58 children (51 boys, seven girls) with a perianal abscess or fistula
- intervention Abscess is best treated by incision and drainage, and fistulectomy is successful for the small proportion who develop a fistula.
- comparator four of whom were initially treated by fistulotomy
- primaryOutcome the frequency of fistula formation complicating perianal abscess
- result After treatment, three developed a further abscess but only four developed a fistula. Fistula formation only occurred in those with enteric bacterial infection.
- result Of 24 children with a perianal fistula five required further surgery for recurrence, four of whom were initially treated by fistulotomy.
- result treatment by fistulectomy resulted in significantly fewer recurrences
- n A consecutive series of 58 children (51 boys, seven girls) with a perianal abscess or fistula
Br J Surg · PMID 9189098 · Read it on PubMed ↗
Makowiec et al. 1997
Perianal abscess in Crohn's disease
Long-term seton did not prevent recurrence.Prospective cohortLow qualityRelated question
126 people32 +/- 17 months
All drainage methods resolved the abscess, but recurrence was common (about 54-62% within two years); a stoma reduced recurrence, superficial fistulas had no recurrence, and long-term seton placement did not prevent recurrence while seton was still in place
Who was studied
Adults with perianal Crohn's disease followed in an outpatient clinic
What they received
Different abscess drainage approaches: seton drainage, mushroom catheter drainage, or simple incision and drainage
Compared with
The drainage methods compared against each other, and presence/absence of a stoma
Main outcome
Occurrence and recurrence of perianal abscesses
Quality
This is an observational, non-randomized follow-up study in a Crohn's-specific population, not a controlled comparison of preventive techniques.
Limitations
No randomization between drainage techniques; population restricted to Crohn's disease patients who often already have fistulas, so findings may not generalize to typical anorectal abscess patients without Crohn's disease.
Taken word for word from the abstract
- population Of 126 consecutive patients with perianal Crohn's disease seen regularly in an outpatient clinic
- n Of 126 consecutive patients with perianal Crohn's disease seen regularly in an outpatient clinic
- intervention Surgical therapy consisted of seton drainage (34 percent), mushroom catheter drainage (49 percent), or incision and drainage (29 percent)
- comparator Abscess recurrence was less frequent in patients with a stoma (13 vs. 60 percent in patients without stoma after two years)
- primaryOutcome we evaluated factors influencing the occurrence and recurrence of perianal abscesses
- result Cumulative two-year recurrence rates after the first and second abscess were 54 and 62 percent, respectively.
- result Long-term use of setons to prevent recurrent abscesses is not supported by our data.
- followUp mean follow-up, 32 +/- 17 months
Dis Colon Rectum · PMID 9106694 · Read it on PubMed ↗
Schaarschmidt et al. 1997
[Pyogenic periproctitis infections in childhood]
Few fistulas after simple drainage.Prospective cohortLow qualityRelated question
128 people1997
5 of 128 children developed an anal fistula after deroofing of anal abscesses, and a quarter had abscess recurrence within 3 weeks to 3 years
Who was studied
children with perianal (anorectal) abscesses
What they received
deroofing (incision and drainage) of anal abscesses
Main outcome
development of an anal fistula after abscess drainage
Quality
This is a single-center observational series without a comparison group, so it cannot show whether any technique actually prevents fistula formation.
Limitations
No comparison between different prevention approaches (e.g. fistulotomy, seton, antibiotics); purely descriptive case series.
Taken word for word from the abstract
- population A total of 128 pediatric pyogenic perianal infections were recorded prospectively in 1984-1995
- intervention deroofing of anal abscesses
- primaryOutcome five children had an anal fistula after deroofing of anal abscesses
- result A quarter of all perianal abscesses developed a recurrence between 3 weeks and 3 years after the initial operation, while five children had an anal fistula after deroofing of anal abscesses.
- n A total of 128 pediatric pyogenic perianal infections were recorded prospectively in 1984-1995
Langenbecks Arch Chir Suppl Kongressbd · PMID 9574424 · Read it on PubMed ↗
Vrzgula et al. 1996
[Simultaneous treatment of an anal abscess and fistula]
No relapses with one-stage fistula treatmentRetrospectiveVery low qualityRelated question
99 people3-32 months
No relapses and no incontinence were recorded during 3-32 months of follow-up in the patients who had their abscess and fistula treated together
Who was studied
Adults with anal abscesses, some first-time and some recurrent, undergoing surgery
What they received
Treating the fistula at the same time as draining the abscess (cutting it open or placing a seton/elastic ligature)
Main outcome
Recurrence of infection and incontinence after surgery
Quality
This is a small, single-center case series without a comparison group, so it cannot show whether treating the fistula early actually prevents fistula formation better than not treating it.
Limitations
No control group of patients treated with drainage alone; small subgroup (28 patients) with fistula; outcome depended on surgeon experience; retrospective design.
Taken word for word from the abstract
- population 99 patients with anal abscesses were operated (70 patients with a first attack and 29 with a relapsing abscess)
- intervention Surgical treatment involved incision, evacuation, drainage and possibly treatment of an anal fistula.
- intervention The anal fistula was treated by decision in 14 patients or by an elastic ligature (multiple seton) in 14 patients.
- primaryOutcome no relapse was recorded nor incontinence due to hard or loose faeces
- result During the postoperative period of 3-32 months in patients subjected to one-stage treatment of the abscess and fistula no relapse was recorded nor incontinence due to hard or loose faeces.
- n 99 patients with anal abscesses were operated
Rozhl Chir · PMID 8768998 · Read it on PubMed ↗
Poenaru et al. 1993
Anal fistula in infants: etiology, features, management
Did not test fistula preventionRetrospectiveLow qualityRelated question
36 peoplemean length of 20 months
No recurrences were observed after fistulotomy or fistulectomy, and only 42% of abscesses went on to form a fistula; this abstract does not compare specific measures taken at the time of abscess drainage to prevent fistula formation
Who was studied
Male infants under age 2 with an anal fistula, most of whom had a prior anorectal abscess
Main outcome
Fistula recurrence and complications after surgical treatment (fistulotomy or fistulectomy)
Quality
it is a small retrospective case series with no comparison group, so it cannot show which drainage-time approach actually prevents fistula formation
Limitations
Retrospective design, no control or comparison group between prevention strategies, abstract text truncated
Taken word for word from the abstract
- n The fistulas were single in 31 patients and double in 5.
- population All patients were males with a mean age of 9.5 months
- population Ninety-two percent have had previous anorectal abscesses.
- primaryOutcome Follow-up was available in 31 patients for a mean length of 20 months.
- result No recurrences were observed and none of the patients had fistula-related complaints at the last visit.
- result only 42% of perianal abscesses will result in fistula formation
J Pediatr Surg · PMID 8308691 · Read it on PubMed ↗
Schouten et al. 1987
Primary partial internal sphincterectomy in the treatment of anorectal abscess
No recurrence or fistula seen.Case seriesVery low quality
74 people1987
none of the 74 patients had a recurrent abscess or persistent fistula after the combined procedure
Who was studied
adults with an anorectal abscess treated by incision and drainage
What they received
adding partial internal sphincterectomy to incision and drainage
Main outcome
recurrence of abscess or development of a chronic anal fistula
Quality
This is a report of outcomes in one group of patients with no comparison group, so it can't show whether the extra procedure actually made the difference.
Limitations
No control group was studied alongside these patients, so results cannot be directly compared to incision and drainage alone; design appears to be a retrospective case series.
Taken word for word from the abstract
- population Anorectal abscess is usually treated by simple incision and drainage.
- intervention partial internal sphincterectomy has been added to the incision and drainage
- primaryOutcome Many patients treated in this way will develop a recurrence of the abscess or a chronic anal fistula.
- result The results with this so-called primary partial internal sphincterectomy in 74 patients were excellent, because of absence of recurrent abscess or persistent fistula.
- n in 74 patients
Neth J Surg · PMID 3587696 · Read it on PubMed ↗
Weber et al. 1984
[Treatment of anorectal fistulas: a still current problem]
Describes fistula surgery, not preventionRetrospectiveVery low qualityRelated question
size not given1984
Laying open the fistula and excising it caused no permanent incontinence, 7% had temporary incontinence, and the recurrence rate was 5%; for complex fistulas a defunctioning colostomy became permanent in over half of patients
Who was studied
Adults with anal fistulas, mostly arising after a cryptoglandular abscess
What they received
Surgical treatment of an already‑formed fistula (laying it open and excising the extrasphincteric part, seton for high fistulas, or colostomy for complex fistulas)
Compared with
No comparison group; different fistula types were treated differently within the same series
Main outcome
Rates of incontinence and fistula recurrence after treatment
Quality
This is a small, uncontrolled retrospective case series describing surgical outcomes, with no numeric sample size and no comparison group.
Limitations
No patient numbers given, no control group, and it reports treatment of already-formed fistulas rather than measures to prevent fistula formation after abscess drainage
Taken word for word from the abstract
- population 95% of our patients have a simple fistula in ano. The majority of these fistulas were following a cryptoglandular abscess.
- intervention No definitive incontinence occurred after laying open the fistula penetrating the anal sphincter and excision of the extrasphincteric part.
- intervention Thereby we usually performed a defunctioning colostomy.
- comparator High fistulas are seldom an indication for a seaton.
- primaryOutcome In only 7% there was a temporary incontinence for faeces or flatus respectively. The recurrence rate was 5%.
- result This became the permanent treatment for more than half of these patients.
Chirurg · PMID 6510077 · Read it on PubMed ↗
Vasilevsky et al. 1984
The incidence of recurrent abscesses or fistula-in-ano following anorectal suppuration
Nearly half developed fistula or recurrenceRetrospectiveLow qualityRelated question
117 people1984
48% of patients with perianal or ischiorectal abscesses later had a recurrent abscess or fistula, supporting waiting for secondary surgery rather than cutting the sphincter muscle at the first operation
Who was studied
adults with anorectal abscesses treated with incision and drainage
Main outcome
developing a recurrent abscess or fistula-in-ano after drainage
Quality
This is a retrospective chart review without a comparison group testing prevention strategies, so it can only describe how often fistulas occurred, not whether any intervention prevents them.
Limitations
Retrospective design, no control group, and no direct comparison of preventive techniques like primary fistulotomy versus drainage alone.
Taken word for word from the abstract
- population a retrospective study of 117 patients who underwent incision and drainage of anorectal abscesses was conducted
- n 117 patients who underwent incision and drainage of anorectal abscesses
- primaryOutcome what percentage of patients would subsequently develop a fistula-in-ano or recurrent abscess
- result nine (11 per cent) developed recurrent abscesses and 31 (37 per cent) developed persistent fistula-in-ano for a combined persistence or recurrence rate of 48 per cent
- result These data support the policy of secondary fistulotomy to avoid division of sphincter muscle in the 52 per cent of patients who would not need it.
Dis Colon Rectum · PMID 6697831 · Read it on PubMed ↗
Nazarov et al. 1980
[Pathogenesis of postoperative complications of paraproctitis and measures for their prevention]
Removing crypts may lower complications.RetrospectiveVery low quality
size not given1980
removing the crypts reduced local postoperative complications and was suggested as a way to help prevent recurrent abscesses or fistulas
Who was studied
adults with acute paraproctitis (anorectal abscess) undergoing surgery
What they received
sanitation of the anal crypts (cryptotomy and cryptectomy) during the main abscess operation
Main outcome
postoperative complications such as cryptitis, microabscesses, recurrent abscess or fistula
Quality
this is an old descriptive report with no control group, no randomization, and no patient numbers given, so it cannot reliably show cause and effect.
Limitations
No comparison group, no stated sample size, and no clear study methodology described in the abstract.
Taken word for word from the abstract
- population acute paraproctitis and anal fistula
- intervention Sanitation of Morgagni crypts (cryptotomy and cryptectomy) during radical operations for paraproctitis
- primaryOutcome postoperative complications--acute and chronic cryptitis and subcutaneous microabscesses
- result decreases the number of local postoperative complications and may be considered as one of the prophylactic measures against recurrent abscesses or anal fistulas
Vestn Khir Im I I Grek · PMID 7376345 · Read it on PubMed ↗
Hanley et al. 1976
Fistula-in-ano: a ten-year follow-up study of horseshoe-abscess fistula-in-ano
Good healing, no recurrenceCase seriesVery low qualityRelated question
41 peopleten-year follow-up (1963 to 1973 treatment period)
all 41 patients healed well with no recurrence over the follow-up period
Who was studied
patients treated for horseshoe-type anal abscess and fistula
What they received
conservative surgical procedure for horseshoe abscess anal fistulas, avoiding cutting the superficial external sphincter
Compared with
none (no comparison group)
Main outcome
healing and fistula recurrence after surgery
Quality
This is an old single-group case series with no comparison treatment, so it cannot show whether this approach prevents fistulas better than any other method.
Limitations
No control group, retrospective review, small sample, and the population already had established horseshoe fistulas rather than simple abscesses where prevention of fistula formation is the question.
Taken word for word from the abstract
- population Forty-one patients were treated from 1963 to 1973.
- intervention The excellent results with minimal deformity of the anus and anal canal are attributed to avoidance of severing the superficial external sphincter between its coccygeal origin and the anus.
- comparator The operation has been used exclusively at the Ochsner Clinic for this problem since 1963.
- primaryOutcome healing was good, and there has been no recurrence
- result Of the 41 patients treated in the period from 1963 to 1973, healing was good, and there has been no recurrence.
- n Forty-one patients were treated from 1963 to 1973.
Dis Colon Rectum · PMID 964108 · Read it on PubMed ↗

How we searchedThe exact query, the date it ran, and what came back — so you can run it yourself.

Searched: PubMed · ClinicalTrials.gov · Crossref on 2026-10-31
The exact search — paste this into PubMed to repeat it: ("Rectal Fistula/prevention and control"[Mesh] OR "anal fistula"[tiab] OR "fistula in ano"[tiab] OR "fistula-in-ano"[tiab]) AND ("Abscess"[Mesh] OR "anorectal abscess"[tiab] OR "perianal abscess"[tiab] OR "perirectal abscess"[tiab]) AND (prevent*[tiab] OR prophylax*[tiab] OR recurrence[tiab]); PubMed expanded that to: ("rectal fistula/prevention and control"[MeSH Terms] OR "anal fistula"[Title/Abstract] OR "fistula-in-ano"[Title/Abstract] OR "fistula-in-ano"[Title/Abstract]) AND ("Abscess"[MeSH Terms] OR "anorectal abscess"[Title/Abstract] OR "perianal abscess"[Title/Abstract] OR "perirectal abscess"[Title/Abstract]) AND ("prevent*"[Title/Abstract] OR "prophylax*"[Title/Abstract] OR "recurrence"[Title/Abstract])
What came back: 140 records found · 139 read · 89 answered the question
Included: Human, animal or laboratory studies reporting an outcome relevant to the question
Excluded: Records about a different condition or intervention
Records reporting no outcome
Retracted publications, which are listed but excluded from every count
Limits: Details were read from abstracts, not full papers, so anything reported only in a paper's methods section is not captured here.
Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured.
Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.

140records came back from the search
139were read
89actually answered the question

Risks and safetyReported side effects and who should be careful.

Cutting or placing material around part of the muscle ring that controls bowel movements (the sphincter), as is done in fistulotomy, carries a risk of fecal incontinence, particularly with more extensive surgery or recurrent disease.
Traditional wound packing after drainage has been described as a painful, costly procedure with no demonstrated clinical benefit; in one trial comparing packing with leaving the wound open, fistula-in-ano occurred in 15% of the packing group versus 11% of the non-packing group, a difference that was not statistically significant.
One randomised trial found that antibiotics after drainage were linked to more fistulas forming, not fewer, so antibiotics are not a guaranteed safeguard and still carry the usual risks of side effects and resistance.

Why people askWhat brings people to this question.

They just had a painful abscess drained and want to avoid ever going through it again.
A doctor mentioned that a fistula sometimes forms after an abscess, and they want to act now to stop it.
They assume that more treatment — antibiotics, packing, extra procedures — must always lower risk.
They want to avoid a second surgery if the fistula can be addressed at the first one.

Common questionsShort answers, drawn from the same studies.

How can I prevent a fistula from coming back after treatment?: Trials that treated the fistula tract (with a seton or fistulotomy) at the same time as drainage had much lower recurrence than drainage alone. There's no trial testing a way to prevent recurrence after a fistula has already been separately treated and healed.
Should I ask for antibiotics after my abscess is drained to prevent a fistula?: The trial evidence is mixed. One randomised trial found fewer fistulas with antibiotics, another randomised trial found more fistulas with antibiotics, and a pooled analysis of six studies called the overall evidence low quality. Antibiotics are not a reliable way to prevent a fistula on current evidence.
Does packing the wound after drainage help prevent a fistula?: No. A randomised trial and a separate pooled analysis both found no difference in fistula or abscess recurrence between packed and unpacked wounds, and packing caused more pain.
Is treating the fistula at the same time as the abscess risky for bowel control?: In the main pooled trial review, adding fistula treatment to drainage did not significantly increase incontinence, but the patients studied were carefully selected as suitable for it. More extensive fistula surgery in other studies has been linked to higher incontinence risk, so this is a decision to make with a surgeon based on your specific anatomy.

What has changedEvery re-check, and whether it changed the answer.

2026-10-31
Re-reviewed under a revised method. 28 new studies · 12 no longer retrieved · evidence strength moderate → high · conclusion signal of harm → not applicable.
How certain we are changed. The conclusion changed.

This is information, not advice

This page summarises published research. It cannot tell you what is happening in your own body, and evidence changes. If something is bleeding, painful, or new, it is worth being looked at — that is a different question from the one on this page, and a better one to bring to a consultation.

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Automated evidence review — PubMed, ClinicalTrials.gov, Crossref. Search strategy, grading rules and the checks that must pass before anything publishes were written by Allen Kamrava, MD, MBA, FACS, FASCRS, colon & rectal surgery, Beverly Hills. The pages themselves are compiled by software running that method and are not read one by one before publication — saying otherwise would be the one claim here that could not be checked.

Allen Kamrava, MD, MBA, FACS, FASCRS · 435 N. Bedford Dr., Suite 308, Beverly Hills, CA 90210 · 424.279.8222

Educational information — not medical advice.