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Allen KamravaMD · MBA · FACS · FASCRS

How can you prevent an anal fistula from forming?

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”
  • “how to prevent a fistula from forming”
  • “how to prevent fistula in ano”
  • “how to prevent fistula recurrence”
  • “how to prevent fistula after abscess”

Evidence review in plain language · compiled 2026-10-13 · checked 2026-10-13 · next 2026-11-13 · automated review, how it works

What the evidence says

Bottom line

No treatment reliably stops a fistula from forming after an abscess is drained, and antibiotics are not a safe bet for prevention.

Six randomised trials have tested different approaches at the time of abscess drainage, and they disagree with each other. The clearest conflict is over antibiotics: one trial found they lowered fistula rates, but a separate, well-conducted placebo-controlled trial found they were linked to more fistulas, not fewer. The most consistent benefit across trials came from treating a fistula tract surgically at the same time as draining the abscess, when one is already visible.

How well studied

Under re-review

This page is being re-checked under a revised method that first confirms each study answers this exact question. Until that is done, no level is shown.

This question weighs several approaches rather than testing one treatment, so there is no single works-or-doesn't verdict.

answer it directly
28answer it directly
studies found
73studies found
randomised trials
6randomised trials
people studied
19,128people studied
reviews of trials
8reviews of trials
years covered
1980–2026years covered

What the research shows

  • Fistula formation after abscess drainage

    Trials disagree sharply. One trial found fewer fistulas with antibiotics after drainage, but a separate, placebo-controlled trial found more fistulas in the antibiotic group. No single method is consistently proven to lower this risk.[1,2]

    Too little evidence

  • Recurrence when a visible fistula is treated during the same abscess operation

    A randomised trial found a sphincter-sparing seton technique done at the time of abscess drainage raised the share of patients with complete healing and no fistula from 41% to 78%, compared with drainage alone. A review of similar trials found fewer repeat surgeries when the fistula tract was treated at the same time, without a clear rise in bowel control problems.[1,2]

    Some evidence

  • Abscess coming back (recurrence)

    A trial comparing needle aspiration with surgical incision and drainage found more recurrences after aspiration (41%) than after incision and drainage (15%), a statistically significant difference. No study in this set reported whether packing the wound after drainage changes the chance of abscess recurrence.[1]

    Too little evidence

  • Need for repeat surgery

    A review of trials found that treating the fistula tract at the same time as draining the abscess reduced the chance of needing repeat surgery, compared with draining the abscess alone.[1]

    Some evidence

  • Wound healing time and post-operative pain

    One trial found not packing the wound caused less pain than packing it, with no difference in fistula or recurrence rates. Another small trial found a negative-pressure suction device sped healing and lowered pain compared with standard gauze dressing.[1,2]

    Some evidence

  • Fecal incontinence or bowel control problems

    One trial that added fistula surgery to abscess drainage found no statistically significant difference in incontinence (loss of bowel control) at one year compared with drainage alone, but the number of incontinence events was small, so a real difference could have been missed. No study in this set reported detailed anal-function testing after sphincter-sparing procedures, so it is not clear whether milder or delayed continence problems were captured.[1]

    Too little evidence

  • Whether antibiotics after drainage prevent fistula

    The best-designed trial here - randomised, placebo-controlled and double-blind - found more fistulas in people given antibiotics after drainage (37%) than those given placebo (22%). A different, lower-quality trial found the opposite. Because the strongest trial points toward harm, antibiotics should not be assumed to prevent fistula.[1,2]

    Some evidence

What the studies found

  • When a fistula tract is already visible at the time the abscess is drained, treating it then - for example with a seton, a thin surgical thread left in the tract - lowered later fistula and recurrence rates compared with draining the abscess alone, in a randomised trial and a review of similar trials.[1,2]
  • Leaving the wound unpacked after drainage caused less pain than packing it, without making fistula or recurrence more likely, in a randomised trial.[1]
  • A small randomised trial found a negative-pressure suction device used after drainage lowered fistula and recurrence rates and sped healing compared with standard gauze dressing changes, though this needs confirming in larger trials.[1]

Important limitations

  • The randomised trials disagree with each other, especially on antibiotics - one found benefit, another found harm. This conflict is the main reason certainty here is only moderate, not high.[1,2]
  • Most of the available evidence is retrospective, comparing groups that were not randomly assigned, so differences between groups rather than the treatment itself could explain some results.[1,2,3,4,5]
  • Several of the randomised trials followed people for only weeks to a few months, which may be too short to catch fistulas that form later.[1,2,3]
  • Many studies combine children and adults, or look only at infants, whose abscesses and healing may behave differently from adults.[1,2,3,4]

What kind of studies

  • Retrospective30 · 41%
  • Case series13 · 18%
  • Narrative review6 · 8%
  • Randomised trial6 · 8%
  • Meta-analysis5 · 7%
  • Prospective cohort4 · 5%
  • Systematic review3 · 4%
  • Registered trial, no results posted2 · 3%
  • Laboratory study1 · 1%
  • Case-control1 · 1%
  • Registry1 · 1%
  • Guideline1 · 1%

The key studies

  • Zhang et al. 2025

    A randomized controlled trial of trans-intersphincteric double seton (TRISDS) for the treatment of perianal abscess

    Fewer fistulas after this draining technique.Randomised trialModerate quality

    106 people12 months

    TRISDS had a significantly higher cure rate (78.2%) than I&D (41.2%), with no difference in anal function at 2 months

    Who was studied
    adults with perianal abscesses below the levator ani muscle with an internal opening
    What they received
    trans-intersphincteric double seton technique (TRISDS) using two loose setons to drain abscess while preserving sphincter
    Compared with
    conventional incision and drainage (I&D)
    Main outcome
    cure rate: complete wound healing without fistula or recurrence within 12 months
    Quality
    it was a randomized trial with a clear primary outcome, but it was not blinded and came from a single center.
    Limitations
    non-blinded, single study, and authors recommend further multicenter studies to confirm findings

    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 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

    Fewer fistulas with no wound packingRandomised trialModerate quality

    433 people6 months

    Non-packing caused less pain and did not increase fistula or abscess recurrence rates

    Who was studied
    adults having surgery to drain a perianal abscess
    What they received
    not packing the wound after drainage
    Compared with
    packing the wound after drainage
    Main outcome
    pain level after surgery
    Quality
    Large multicentre randomized trial with blinded outcome assessment, but fistula and recurrence differences were not statistically significant so those findings are less certain.
    Limitations
    Fistula and recurrence differences between groups were not statistically significant (P = 0.20 for both)

    Taken word for word from the abstract

    • n 433 participants (mean age 42 years) were randomized across 50 sites
    • 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).
    • 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 ↗

  • Sørensen et al. 2021

    Needle aspiration treatment vs. incision of acute simple perianal abscess: randomized controlled study

    No fewer fistulas; more recurrence.Randomised trialModerate quality

    98 people52 weeks

    abscess recurrence was higher with needle aspiration (41%) than with incision drainage (15%); fistula formation was 15% with no significant difference between groups

    Who was studied
    adults with an acute perianal abscess
    What they received
    needle aspiration of the abscess plus a week of antibiotics (clindamycin)
    Compared with
    conventional surgical incision and drainage of the abscess
    Main outcome
    abscess coming back (recurrence)
    Quality
    it was a randomized trial across three centers, but had a modest number of patients which limits certainty, especially for the less common fistula outcome.
    Limitations
    abstract does not report blinding, and fistula formation subgroup difference may be underpowered given the overall sample size

    Taken word for word from the abstract

    • population adults with acute perianal abscess
    • intervention The needle aspiration group received clindamycin for one week postoperatively
    • comparator conventional surgical incision drainage of acute perianal abscess
    • primaryOutcome The primary outcome was abscess recurrence.
    • result The recurrence rate was 41% in needle aspiration and 15% in incision drainage, with HR of 3.033 (p = 0.014). Fistula formation was 15% without significant difference between the groups.
    • n A total of 98 patients were included.
    • followUp follow-up at 2, 12, and 52 weeks postoperatively

    Int J Colorectal Dis · PMID 33447866 · 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 device.Randomised trialModerate quality

    80 people12 to 36 (24±5) months

    lower rate of anal fistula formation and abscess recurrence, higher one-time cure rate, less pain and faster healing with negative pressure device

    Who was studied
    adults with a first-time high perianal abscess
    What they received
    closed negative pressure irrigation and suction device after abscess drainage
    Compared with
    conventional incision and drainage with gauze dressing changes
    Main outcome
    rate of anal fistula formation and abscess recurrence after surgery
    Quality
    it was a randomized trial but came from a single center with a modest number of patients and excluded complex cases like diabetes or Crohn's disease.
    Limitations
    single-center study, excluded patients with diabetes, immunosuppression, Crohn's disease, or recurrent abscess, which limits how broadly results apply

    Taken word for word from the abstract

    • n There were both 40 patients in the negative pressure irrigation and suction group and the conventional drainage group.
    • 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 drainage group: conventional incision and drainage was carried out.
    • primaryOutcome recurrence rate of perianal abscess, anal fistula formation rate were observed
    • result the recurrence rate of perianal abscess within 1 year after operation and 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]

    Zhonghua Wei Chang Wai Ke Za Zhi · PMID 31054551 · 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 prevented fistulas.Randomised trialModerate quality

    299 people3 months

    significantly fewer patients who took antibiotics developed an anal fistula

    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 only, no antibiotics
    Main outcome
    development of anal fistula within 3 months
    Quality
    it was a randomized trial but only single-blind and from one hospital, so bias and generalizability are limited
    Limitations
    single blind design and seven patients lost to follow-up

    Taken word for word from the abstract

    • n 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
    • population 307 patients were randomly selected from those referring for incision and drainage of perianal abscess at Shahid Faghihi Hospital, Shiraz, Iran
    • intervention receive 7 days of oral metronidazole and ciprofloxacin in addition to their standard care
    • comparator 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).

    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, worse rate.Randomised trialModerate quality

    151 people1-year follow-up

    fistulas formed in more patients given antibiotics (37.3%) than placebo (22.4%)

    Who was studied
    adults who had surgical drainage of an anorectal abscess
    What they received
    antibiotics (amoxicillin-clavulanic acid) for 10 days after abscess drainage
    Compared with
    placebo after abscess drainage
    Main outcome
    development of an anal fistula within 1 year
    Quality
    it was a randomized, placebo-controlled, double-blind multicenter trial, but many patients were lost between randomization and final analysis, weakening confidence.
    Limitations
    Only 151 of 183 randomized patients had data available for per-protocol analysis, and the study excluded recurrent, secondary, or complicated abscesses.

    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)

    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 surgeryMeta-analysisModerate quality

    479 peopleone year

    significantly fewer recurrences or repeat surgeries when fistula was treated at the same time, with no significant increase in incontinence

    Who was studied
    patients with perianal abscess
    What they received
    surgery to treat the anal fistula at the same time as draining the abscess
    Compared with
    draining the abscess alone without fistula treatment
    Main outcome
    recurrent or persistent abscess/fistula needing repeat surgery, and incontinence
    Quality
    this pools six randomized trials but with only 479 patients total and some inconsistency between trials on the incontinence outcome
    Limitations
    heterogeneity between trials on incontinence outcome, and small number of included trials

    Taken word for word from the abstract

    • n We identified six trials, involving 479 subjects
    • population The perianal abscess is a common surgical problem.
    • intervention comparing incision and drainage of perianal abscess alone versus incision and drainage with fistula treatment
    • comparator comparing incision and drainage of perianal abscess alone versus incision and drainage with fistula treatment
    • 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 73 studiesEvery study that answered the question, with its design, size and result.
The other 66 studiesEverything else the search returned, including anything retracted.

  • Yu 2026

    Sphincter-induced dynamic obstruction in a synthetic intersphincteric anal fistula model: a proof-of-concept fluid-structure interaction study

    Muscle squeezing may trap fistula fluidLaboratory studyVery low qualityRelated question

    size not given2026

    sphincter contraction created large areas of very slow fluid movement even though the tract itself stayed open

    Who was studied
    a model built from MRI of a healthy volunteer, used to simulate an anal fistula tract
    What they received
    simulated contraction of the anal sphincter muscle around a synthetic fistula tract
    Compared with
    no comparator group; different stages of the simulated contraction were compared
    Main outcome
    fluid flow speed inside the fistula tract, looking for areas where fluid gets stuck
    Quality
    this is a computer simulation based on one healthy volunteer's anatomy with an artificial fistula, not a real patient or clinical test, so it cannot show whether this actually causes or prevents fistulas.
    Limitations
    the abstract states this is a synthetic model in a healthy volunteer, described as 'qualitative proof-of-concept evidence pending validation in patient-specific native fistula models and clinical studies'

    Taken word for word from the abstract

    • population A subject-specific fluid-structure interaction model was constructed from high-resolution pelvic MRI.
    • population healthy-volunteer-derived, synthetic intersphincteric fistula model
    • intervention Time-dependent physiological loading simulated sphincter contraction, and bidirectional analyses were performed.
    • comparator RESULTS: Sphincter contraction induced extensive low-velocity regions despite anatomical patency, with a progressive increase during mid-loading.
    • primaryOutcome Intraluminal velocity fields were quantified using an image-based inverse mapping approach to characterize low-velocity retention zones.
    • result Sphincter contraction induced extensive low-velocity regions despite anatomical patency, with a progressive increase during mid-loading.
    • result these findings support a plausible biomechanical hypothesis for ineffective fistula drainage, but should be interpreted as qualitative proof-of-concept evidence pending validation in patient-specific native fistula models and clinical studies.

    Front Med (Lausanne) · PMID 42500525 · Read it on PubMed ↗

  • 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

    Fewer fistulas with added LIFT procedureRetrospectiveLow quality

    111 people6 months

    persistent fistula occurred in 38.2% of drainage-only patients versus 5.7% of drainage-plus-LIFT patients at 6 months

    Who was studied
    patients with deep perianal abscess and transsphincteric fistula
    What they received
    incision and drainage combined with LIFT (ligation of intersphincteric fistula tract) procedure
    Compared with
    incision and drainage alone
    Main outcome
    persistent fistula at 6 months confirmed by exam and MRI
    Quality
    This is a retrospective, non-randomized comparison, so differences between groups could explain the results rather than the treatment itself.
    Limitations
    non-randomized design; authors state findings require confirmation through prospective randomized controlled trials

    Taken word for word from the abstract

    • population Patients with deep perianal abscess (DPA) and transsphincteric fistula
    • intervention incision and drainage combined with the LIFT procedure
    • comparator incision and drainage alone
    • 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: Group I (incision and drainage alone, n = 57) and Group II (incision and drainage combined with the LIFT procedure, n = 54)
    • limitations These findings should be interpreted with caution due to the non-randomized design and require confirmation through prospective randomized controlled trials.

    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"

    Gentler treatment in infants may lower fistula riskNarrative reviewVery low qualityRelated question

    size not given2026

    Surgical drainage may raise fistula risk, especially in older children, while conservative treatment often works well in infants

    Who was studied
    children with perianal abscesses
    What they received
    age-specific management (antibiotics/observation in infants, surgery considered in older children)
    Compared with
    surgical incision and drainage versus conservative treatment
    Main outcome
    fistula formation and recurrence
    Quality
    This is a narrative review summarizing other studies and opinions, not new controlled data, so it can't reliably prove what prevents fistulas.
    Limitations
    Narrative review without stated systematic methodology, no original patient data, numbers, or statistical results reported; identifies gaps and calls for more research.

    Taken word for word from the abstract

    • population Pediatric perianal abscesses represent a frequent yet underrecognized condition
    • intervention conservative strategies including antibiotic therapy and observation are often effective in infants and young children
    • comparator Surgical interventions such as incision and drainage offer rapid symptom relief but may increase the risk of fistula formation
    • 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

    Front Pediatr · PMID 42221001 · 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 and recurrence rates after surgery.Case seriesLow quality

    308 people37.9 ± 16.8 months

    4.9% developed a fistula afterward and 8.1% had the abscess come back, with an overall treatment success rate of 87.0%

    Who was studied
    patients who had surgery for perianal abscesses caused by infected anal glands
    What they received
    a surgical technique called three-cavity clearance (TCC)
    Main outcome
    whether an anal fistula formed or the abscess came back after surgery
    Quality
    This is a single-center case series looking back at one group of patients with no comparison group, so it can't show whether this technique is better than other treatments.
    Limitations
    Single-center, retrospective design with no comparator group, relying on risk-factor modeling rather than a controlled trial.

    Taken word for word from the abstract

    • n A total of 308 patients were included from January 2018 to January 2024
    • population glandular perianal abscesses
    • intervention three-cavity clearance (TCC)
    • 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%.
    • followUp average follow-up time of 37.9 ± 16.8 months

    Tech Coloproctol · PMID 42132969 · 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

    Early fistula predicts fistula coming back.RetrospectiveLow qualityRelated question

    108 people2026

    Fistula recurrence was much more common in children who already had a fistula at the first operation (31.6%) than in those who did not (10.1%); antibiotics, abscess size, and how long symptoms lasted did not predict recurrence.

    Who was studied
    children aged 0 to 17 who had surgery for a perianal abscess or anal fistula
    What they received
    having a fistula present at the time of the first surgery
    Compared with
    not having a fistula present at the time of the first surgery
    Main outcome
    return of the fistula or abscess after treatment
    Quality
    It is a single-center look-back study without randomization, so it can show patterns but not prove what prevents fistulas.
    Limitations
    Retrospective design, single tertiary center, and ultrasound often gave no definitive answer for fistula detection (67 of 99 cases).

    Taken word for word from the abstract

    • n We retrospectively reviewed 108 pediatric patients (0-17 years) treated surgically for PA and/or FIA between January 2019 and February 2024
    • population 108 pediatric patients (0-17 years) treated surgically for PA and/or FIA between January 2019 and February 2024 at a tertiary care center
    • intervention Intraoperative FIA was identified in 19/108 patients (17.8%)
    • comparator Recurrence of PA was more frequent in those with initial FIA (36.8%) than without (24.7%)
    • primaryOutcome evaluate recurrence rates after surgical treatment of PA and FIA and identify clinical factors associated with fistula formation
    • result FIA recurrence was significantly higher in patients with initial FIA (31.6% vs 10.1%, P=0.024)
    • result Antibiotic therapy, abscess size, and symptom duration showed no significant association with recurrence or FIA development.

    Med Sci Monit · PMID 41578630 · Read it on PubMed ↗

  • Mersal et al. 2026

    Beyond the Knife: A Contemporary Review of Subcutaneous Abscesses

    Antibiotics may modestly lower fistula risk.Narrative reviewLow quality

    size not given2026

    trials disagree, but pooled data suggest a modest benefit from antibiotics in reducing fistula formation

    Who was studied
    people with perianal abscesses
    What they received
    antibiotics given after incision and drainage
    Compared with
    incision and drainage without antibiotics
    Main outcome
    prevention of fistula-in-ano (anal fistula) formation
    Quality
    this is a review summarizing conflicting trials rather than new controlled data, so the evidence behind this specific claim is weak and inconsistent
    Limitations
    abstract itself states the trials conflict and that clinical judgment still matters

    Taken word for word from the abstract

    • population perianal abscesses, where the risk of developing a fistula-in-ano is substantial
    • intervention adding a short course of MRSA-active antibiotics to I&D
    • comparator whether adjunct antibiotics improve cure rates or prevent recurrence
    • primaryOutcome the goal shifts to preventing fistula-in-ano
    • result here the trials conflict, pooled estimates hint at a modest benefit from antibiotics, and clinical judgment still matters

    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 may lower fistula recurrence risk.RetrospectiveLow quality

    109 peopleapproximately 30 months

    absence of antibiotic therapy after incision was linked to higher recurrence risk (OR 0.44)

    Who was studied
    adults with a first-time perianal (anal) abscess treated with incision
    What they received
    antibiotic therapy given after incision of the abscess
    Compared with
    incision alone without antibiotics
    Main outcome
    rate of patients needing fistula surgery and/or having the abscess come back
    Quality
    This was a small retrospective study using only univariate analysis, so the antibiotic link to fewer fistulas is not strongly proven.
    Limitations
    Retrospective design, no multivariate analysis due to insufficient data, and authors call for randomized trials to confirm findings.

    Taken word for word from the abstract

    • n Among 109 patients (mean age 43 ± 13 years; 74 % male)
    • population all patients presenting in 2019 with a first perianal abscess treated by incision under local anesthesia
    • intervention with or without antibiotic therapy post-incision
    • comparator 55 had incision alone
    • primaryOutcome The primary outcome was the rate of patients requiring fistula surgery and/or experiencing abscess recurrence
    • result Univariate logistic regression analysis revealed smoking and absence of antibiotic therapy post-incision as predictive of recurrence with (OR 0.44)
    • 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

    Several risk and protective factors identified.Case-controlLow quality

    435 people25 months (range 18-40 months)

    several factors were independently linked to fistula formation, including abscess history, enteritis, residual pus cavity, surgeon specialty, Parks classification and Wexner score, while standardized dressing changes and preoperative imaging were linked to lower risk

    Who was studied
    patients who had surgery for a perianal abscess
    What they received
    standardized dressing changes after discharge, preoperative ultrasound or MRI scan, and postoperative anal function assessment
    Compared with
    patients with a history of abscesses, enteritis, intraoperative pus cavity residue, and other risk factors
    Main outcome
    formation of an anal fistula after perianal abscess surgery
    Quality
    It is a retrospective observational study with only 27 fistula cases, so it can show links but not prove these factors actually prevent fistulas.
    Limitations
    Retrospective design, small number of fistula events, and reliance on multivariate analysis rather than a controlled trial.

    Taken word for word from the abstract

    • n A total of 435 patients were included in the study
    • population patients with perianal abscesses who underwent surgical treatment
    • intervention Standardized dressing changes after discharge, a preoperative ultrasound or MRI scan, and a postoperative assessment of anal function (Wexner score) are important for protecting anal sphincter function and improving the prognosis of perianal abscesses.
    • comparator A history of abscesses and enteritis, Parks classification, and intraoperative pus cavity residue are high-risk factors for anal fistula recurrence.
    • 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 (P < 0.05).
    • 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

    No difference in fistula prevention.Systematic reviewLow quality

    size not given2025

    about 21% developed a fistula after non-surgical care versus 20% after surgical drainage, with no clear difference between approaches

    Who was studied
    infants with perianal abscess or anal fistula
    What they received
    surgical drainage or fistula surgery
    Compared with
    non-operative care such as hygiene, warm baths, and antibiotics
    Main outcome
    rate of developing an anal fistula after treatment
    Quality
    based on a mix of lower-quality studies (level 3-4 evidence) without randomized trials, so the comparison between treatments is uncertain.
    Limitations
    Level 3-4 studies only; no randomized controlled trials; wide variation in time to resolution not explained

    Taken word for word from the abstract

    • population Management of infant perianal disease, including perianal abscess and fistula-in- ano (FIA)
    • intervention operative intervention for abscess only (incision and drainage (I&D)) or direct surgical management of the FIA (e.g. upfront fistulotomy)
    • comparator nonoperative management (NOM) strategies (such as hygiene, sitz baths, and systemic antibiotics)
    • primaryOutcome The rate of FIA development is approximately 21 % after NOM and 20 % after I&D.
    • result The rate of FIA development is approximately 21 % after NOM and 20 % after I&D.
    • result 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 ↗

  • He et al. 2025

    Gut microbiota and perianal abscess and anal fistula: A bidirectional Mendelian randomization study

    Certain gut bacteria linked to fistula risk.RegistryLow qualityRelated question

    size not given2025

    Several gut bacteria types were linked to higher or lower risk of perianal abscess and anal fistula; some bacteria increased risk, others appeared protective, based on genetic analysis

    Who was studied
    people studied using genetic data on gut bacteria and perianal abscess/anal fistula
    What they received
    specific gut bacteria types (genetically predicted levels)
    Compared with
    other gut bacteria types / genetic variation without these bacteria
    Main outcome
    risk of developing perianal abscess or anal fistula
    Quality
    This is a genetic correlation study, not a trial testing an actual prevention method, so it cannot show that changing gut bacteria would actually prevent fistulas.
    Limitations
    Abstract does not report study limitations beyond stating sensitivity analyses were robust; no human intervention was tested, only genetic association data was used.

    Taken word for word from the abstract

    • population Perianal abscess and anal fistula are debilitating surgical conditions
    • intervention Four gut microbiota taxa showed causal associations with perianal abscess risk
    • comparator Reverse MR analyses did not suggest reverse causality.
    • primaryOutcome causal associations with perianal abscess risk
    • result Catenibacterium (OR = 1.22, P = .042) and Eubacterium ruminantium group (OR = 1.17, P = .013) increased risk, while Haemophilus (OR = 0.79, P = .005), Alloprevotella (OR = 0.78, P = .001), Ruminiclostridium5 (OR = 0.79, P = .019), Erysipelotrichaceae UCG003 (OR = 0.82, P = .034), Butyrivibrio (OR = 0.88, P = .006), and Escherichia-Shigella (OR = 0.82, P = .039) conferred protection.

    Medicine (Baltimore) · PMID 40898530 · Read it on PubMed ↗

  • Chen et al. 2025

    Treatment of perianal abscess and anal fistula in infants: a systematic review

    No difference between surgery and waiting.Systematic reviewLow quality

    1,770 people2025

    similar cure and recurrence rates between conservative and surgical treatment, with fistula developing in about a quarter of cases either way

    Who was studied
    perianal abscess (PA) and fistula-in-ano (FIA) in infants
    What they received
    conservative treatment (non-surgical)
    Compared with
    surgical treatment
    Main outcome
    cure rate and recurrence (including new fistula formation)
    Quality
    based only on pooled retrospective studies without randomization, so differences between treatments are uncertain.
    Limitations
    all included studies were retrospective; no randomized trials.

    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 Of the 702 cases (38.7%) that underwent conservative treatment, 528 cases (75.2%) achieved a cure
    • comparator among the 1,068 cases (61.3%) that received surgical interventions, 784 cases (73.4%) were cured
    • primaryOutcome 174 cases (24.8%) were unsuccessful, with 93 experiencing PA recurrence and 81 developing FIA
    • 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 ↗

  • 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, not fistula rates.RetrospectiveLow qualityRelated question

    116 people3 (IQR 2-6) months

    Abscess recurrence was higher with non-operative management (53%) than surgery (23%), and surgery lowered recurrence risk, but fistula rates afterward were similar between groups

    Who was studied
    infants aged ≤12 months presenting with PA
    What they received
    surgical incision and drainage of perianal abscess
    Compared with
    non-operative management (antibiotics and/or aspiration under local anaesthetic)
    Main outcome
    recurrence of perianal abscess and development of fistula-in-ano
    Quality
    This is a retrospective, non-randomized study from two centres with short follow-up, so differences could be due to other factors rather than treatment choice.
    Limitations
    Retrospective design, management based on surgeon preference, short median follow-up of 3 months, and no randomisation to treatment groups.

    Taken word for word from the abstract

    • n 116 infants were identified
    • 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 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).
    • 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

    Early thorough drainage cuts recurrence risk.RetrospectiveLow qualityRelated question

    525 peopleOne year post-follow-up

    Overall recurrence was 39%, much higher for abscesses classed as fistula-prone (81.0%) than non-fistula-prone (23.5%); delaying surgery 7+ days, chronic diarrhea, and local anesthesia raised recurrence risk, while prompt thorough drainage lowered it

    Who was studied
    adults with anorectal abscesses treated with incision and drainage only at a hospital
    What they received
    incision and drainage performed promptly (within 7 days of symptoms)
    Compared with
    incision and drainage delayed 7 or more days after symptoms, or done under local anesthesia
    Main outcome
    abscess coming back or turning into a fistula after surgery, tracked for one year
    Quality
    It only looked back at hospital records from one center without comparing treatments head-to-head, so it can show links but not prove what truly prevents fistulas.
    Limitations
    Retrospective single-center design, no randomization, relies on electronic records, so findings show association with recurrence rather than proven prevention of fistula formation.

    Taken word for word from the abstract

    • n In this retrospective study, 525 patients with anorectal abscesses treated by incision and drainage alone, at a tertiary general hospital from August 2012 to July 2022, were included.
    • 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
    • intervention Prompt and thorough incision and drainage can significantly reduce postoperative recurrence.
    • comparator ≥ 7 days between symptom onset and surgery, chronic diarrhea, preoperative antibiotic use, and local anesthesia were risk factors for recurrence
    • primaryOutcome To evaluate factors that predict postoperative recurrence of anorectal abscesses and propose a new classification to guide surgical procedures.
    • result the overall recurrence rate was 39%:81.0% and 23.5% for fistula-prone and non-fistula-prone abscesses, respectively.
    • followUp One year post-follow-up

    World J Gastrointest Surg · PMID 39649212 · Read it on PubMed ↗

  • Kata et al. 2024

    Anorectal Abscess

    No clear way to prevent fistula yet.Narrative reviewVery low qualityRelated question

    size not given2024

    Review states 30 to 50% develop a fistula after drainage; whether antibiotics prevent this is still being studied and early fistulotomy is controversial

    Who was studied
    people with an anorectal abscess
    What they received
    draining the abscess (with discussion of antibiotics and primary fistulotomy)
    Compared with
    different drainage/management approaches, with or without antibiotics or fistulotomy
    Main outcome
    whether an anal fistula develops after treatment
    Quality
    This is a narrative review discussing general practice and open questions, not a study measuring outcomes itself.
    Limitations
    No original data, sample size, or methods are given; it summarizes general knowledge and notes some questions are unresolved.

    Taken word for word from the abstract

    • population Anorectal abscesses are a common colorectal emergency.
    • intervention The hallmark of treatment is obtaining source control while avoiding injury to the underlying sphincter complex.
    • comparator Primary fistulotomy at time of the index drainage is controversial; however, there may be situations where it is appropriate.
    • primaryOutcome they have a 30 to 50% chance of developing an anal fistula that will then require further treatment
    • result Whether antibiotics prevent future fistula formation is an area of active research.
    • 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 prevention finding reported.Narrative reviewVery low qualityRelated question

    size not given2024

    the abstract does not report a specific outcome, only general discussion of treatment tradeoffs

    Who was studied
    people with anal gland infections and fistulas
    What they received
    different fistula treatments including sphincter-cutting surgery
    Compared with
    sphincter-sparing fistula treatments
    Main outcome
    balance between incontinence risk and fistula coming back
    Quality
    this is a narrative review discussing general treatment considerations without presenting original data or outcomes.
    Limitations
    this is a review article that does not report original study data, numbers, or specific results comparing treatments.

    Taken word for word from the abstract

    • population Anal suppurative processes are commonly encountered in surgical practice
    • intervention the initial therapeutic intervention is philosophically straightforward (incision and drainage)
    • comparator the higher risk of fistula recurrence with all sphincter-sparing fistula treatments
    • 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 drainage of the appropriate space and treatment of the subsequent fistula in ano require a thorough understanding of perianal anatomy and nuanced decision making

    Surg Clin North Am · PMID 38677815 · Read it on PubMed ↗

  • Polaino Moreno et al. 2024

    Efficacy of amoxicillin/clavulanic acid after surgical drainage of perianal abscess in the prevention of the development of anal fistula (PERIQxA study): study protocol for a multicenter randomized, double-blind clinical trial

    No results yet; trial planned.Registered trial, no results postedLow quality

    286 people6 months

    no results yet; this is a study protocol

    Who was studied
    adults who had surgery to drain a perianal abscess
    What they received
    amoxicillin/clavulanic acid antibiotic for 7 days
    Compared with
    placebo
    Main outcome
    percentage of patients who develop an anal fistula after surgery
    Quality
    this is only a trial protocol with no results reported yet, so no conclusion can be drawn.
    Limitations
    The abstract reports no results; it only describes the planned study design.

    Taken word for word from the abstract

    • n The study has been designed to include 286 adult patients
    • population after surgical drainage of perianal abscess
    • intervention experimental (amoxicillin/clavulanic acid 875/125 mg TDS for 7 days)
    • comparator control arm (placebo)
    • primaryOutcome The primary outcome measure is the percentage of patients that develop perianal fistula after surgery and during follow-up (6 months).
    • result The results of this study are expected to contribute to stablish the potential role of antibiotherapy in the therapeutics for anal abscess.

    Trials · PMID 38355562 · Read it on PubMed ↗

  • Ye et al. 2023

    Restricted cubic spline model analysis of the association between anal fistula and anorectal abscess incidence and body mass index

    Higher body weight linked to more fistulas.RetrospectiveLow qualityRelated question

    1,223 people2023

    overweight and obesity were linked to higher odds of anal fistula and anorectal abscess, with a J-shaped relationship between BMI and risk

    Who was studied
    outpatients seen at a proctology clinic, some with anal fistula or anorectal abscess and some healthy controls
    What they received
    having a higher body mass index (overweight or obesity)
    Compared with
    normal-weight individuals
    Main outcome
    developing anal fistula or anorectal abscess
    Quality
    This is a retrospective observational study looking at associations, not a trial testing a way to prevent fistulas, so it cannot prove that losing weight prevents them.
    Limitations
    Retrospective cross-sectional design, so it can show association but not prove cause, and it does not test any actual prevention method.

    Taken word for word from the abstract

    • n The present study included 1,223 participants, including 1,018 males and 206 females, with 275 anal fistulas, 184 anorectal abscesses, and 765 healthy controls.
    • population We conducted a retrospective analysis of outpatients who visited the proctology department at China-Japan Friendship Hospital between January 2017 and May 2022.
    • intervention people with overweight or obesity were more prone to anal fistula
    • comparator than normal-weight individuals
    • primaryOutcome the potential influential factors associated with anal fistula and anorectal abscess
    • result It was indicated that people with overweight or obesity were more prone to anal fistula (OR overweight = 1.35, 95% CI: 1.00-1.82, P = 0.047; OR obesity = 3.44, 95% CI: 2.26-5.26, P < 0.001) or anorectal abscess (OR overweight = 1.41, 95% CI: 1.00-1.99, P = 0.05; OR obesity: 2.24, 95% CI: 1.37-3.67, P = 0.001) than normal-weight individuals.

    Front Surg · PMID 38259976 · Read it on PubMed ↗

  • Turner et al. 2024

    Management of acute perianal abscess: is surgeon specialization associated with improved outcomes?

    Surgeon specialty didn't change fistula or recurrence rates.RetrospectiveLow qualityRelated question

    408 people2024

    no difference in risk of recurrent abscess or later fistula between colorectal and non-colorectal surgeons

    Who was studied
    patients admitted with perianal abscess (excluding those with IBD, recent fistula treatment, or non-cryptoglandular sepsis)
    What they received
    abscess surgery performed by a colorectal specialist surgeon
    Compared with
    abscess surgery performed by a non-colorectal general surgeon
    Main outcome
    abscess coming back (recurrence), and later fistula development
    Quality
    This is a retrospective cohort study with likely selection bias, as the authors themselves note.
    Limitations
    Retrospective design with potential selection bias; colorectal surgeons more often identified fistulas at surgery, which could affect comparability between groups.

    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
    • n Four-hundred and eight patients were included (150 CR, 258 non-CR).
    • intervention Patients admitted under an ASU colorectal (CR) consultant
    • comparator compared with those under a non-CR general surgeon
    • 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)).
    • result Subsequent fistula developed in 14.7% in both groups.
    • qualityWhy Surgeon specialization was not associated with improved outcomes for ASU patients with perianal abscess, albeit with potential selection bias.

    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 factors linked to fistula risk.RetrospectiveLow qualityRelated question

    475 peoplemedian follow-up time of 1108 days (IQR 946-1320 days)

    certain factors - low intersphincteric or ischioanal abscess location, Crohn's disease, repeat abscesses or repeat surgery, E. coli in the pus, and high CRP - were linked to higher odds of later fistula

    Who was studied
    adults who had surgery to drain an anal abscess
    What they received
    none - this study did not test a treatment, it looked for risk factors after standard abscess drainage surgery
    Compared with
    patients without those risk factors
    Main outcome
    whether an anal fistula developed after abscess surgery
    Quality
    it is a retrospective chart review from patient records, which can miss data and cannot prove these factors actually cause fistulas rather than just being associated with them
    Limitations
    retrospective design, reliance on coded records, and no testing of any preventive intervention

    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
    • intervention This study aimed to identify the risk factors for anal fistulas after anal abscess surgery.
    • comparator Predefined clinicopathological factors and postoperative courses were extracted from patient records.
    • 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).
    • followUp median follow-up time of 1108 days (IQR 946-1320 days)

    Int J Colorectal Dis · PMID 38093036 · Read it on PubMed ↗

  • Yin et al. 2023

    Natural course of perianal abscess in infants: a real-world study

    Most abscesses healed without surgery.RetrospectiveLow qualityRelated question

    153 people5.3 years

    most infants (90.8%) were cured without surgery; only about 7.2% needed surgery and 2% developed fistula-in-ano

    Who was studied
    infants with perianal abscess treated without surgery
    What they received
    conservative (non-surgical) treatment of perianal abscess
    Main outcome
    cure rate, fistula formation, abscess recurrence
    Quality
    This is a retrospective single-center study without a comparison group, so it cannot prove what prevents fistula formation.
    Limitations
    Retrospective design, single center, no control group, parents' refusal of surgery introduces selection bias.

    Taken word for word from the abstract

    • population A retrospective cohort study was conducted in 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 Overall, 139 patients (90.8%) were cured conservatively without surgery, and 11 (7.2%) underwent surgical management.
    • 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

    Surgical method and abscess size affect fistula risk.RetrospectiveLow quality

    394 people2023

    larger abscess cavity size and type of surgical method used were independent risk factors for recurrence or fistula formation after surgery

    Who was studied
    patients who had surgery for a perianal abscess
    What they received
    different surgical methods for treating the abscess (including precise clearance of the infected gland)
    Compared with
    simple drainage surgery
    Main outcome
    abscess recurrence or formation of an anal fistula after surgery
    Quality
    this is a retrospective review of patient records without randomization, so it can show links but not prove that a surgical method actually causes fewer fistulas.
    Limitations
    retrospective design, no randomization, and reliance on records for factors like preoperative imaging and abscess characteristics.

    Taken word for word from the abstract

    • population The clinical data of 394 patients with perianal abscesses were collected
    • n The clinical data of 394 patients with perianal abscesses were collected
    • intervention surgical method
    • comparator simple drainage
    • primaryOutcome 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 ↗

  • Lin et al. 2023

    The Optimal Primary Treatment for Pediatric Perianal Abscess and Anal Fistula: A Systemic Review and Meta-Analysis

    Early surgery reduced fistula recurrence.Meta-analysisLow qualityRelated question

    2,507 people2023

    Surgery as the first treatment lowered recurrence compared with drainage alone, and conservative treatment had more recurrence than surgery, though not statistically significant

    Who was studied
    children under 18 with perianal abscess or anal fistula
    What they received
    surgery (fistula surgery) as first treatment
    Compared with
    conservative treatment or incision/drainage alone
    Main outcome
    recurrence of abscess or fistula after initial treatment
    Quality
    It pools mostly retrospective studies with no randomized trials, so the comparisons are prone to bias.
    Limitations
    No randomized controlled trials were identified; studies were mostly retrospective; subgroup analysis of different treatment approaches could not be performed due to lack of information.

    Taken word for word from the abstract

    • n Thirty-one studies involving 2507 pediatric patients met the inclusion criteria.
    • population patient age of <18 years
    • intervention initial surgical intervention for pediatric patients with perianal abscesses and anal fistula
    • comparator Compared with incision/drainage, surgery can prevent recurrence remarkably
    • 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).

    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

    Fistula probing linked to fewer recurrences.RetrospectiveLow quality

    103 people2022

    fistula probing was linked to treatment success; prior 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
    fistula probing (and fistulotomy if a fistula was found) during abscess surgery
    Compared with
    abscess surgery without fistula probing
    Main outcome
    recurrence of perianal abscess or development of anal fistula
    Quality
    this is a retrospective study without randomization, so other factors could explain the link between fistula probing and better outcomes
    Limitations
    retrospective design, no randomization, and comparisons based on univariate and multivariate statistics rather than controlled trial

    Taken word for word from the abstract

    • population We performed a retrospective review of 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).
    • n Out of 103 enrolled patients, 27 (26%) had recurrent perianal disease.

    Front Surg · PMID 36589625 · Read it on PubMed ↗

  • van Oostendorp et al. 2022

    Antibiotic Treatment foLlowing surgical drAinage of perianal abScess (ATLAS): protocol for a multicentre, double-blind, placebo-controlled, randomised trial

    Trial planned, no results yetRegistered trial, no results postedLow quality

    298 people1 year

    no results yet, this is a trial protocol

    Who was studied
    adults with a perianal abscess after surgical drainage
    What they received
    antibiotics (ciprofloxacin and metronidazole) added to surgical drainage
    Compared with
    surgical drainage alone plus placebo
    Main outcome
    development of an anal fistula within 1 year
    Quality
    this is only a planned trial with no outcomes reported yet
    Limitations
    study has not yet reported results; only protocol described

    Taken word for word from the abstract

    • n the total sample size will be 298 participants
    • population surgical drainage of perianal abscess
    • intervention addition of antibiotics (ciprofloxacin and metronidazole) to surgical drainage of a perianal abscess
    • comparator surgical drainage alone
    • primaryOutcome The primary outcome is the development of a perianal fistula within 1 year.
    • result The results of this trial will be submitted for publication in international peer-reviewed journals

    BMJ Open · PMID 36351727 · 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 quality

    457 people2022

    no difference between non-surgical and surgical groups in recurrence or fistula formation rates

    Who was studied
    children with a first-time perianal abscess and/or fistula-in-ano
    What they received
    non-surgical management of the abscess/fistula
    Compared with
    surgical incision and/or drainage
    Main outcome
    rates of abscess recurrence and fistula-in-ano formation
    Quality
    This is a retrospective study comparing treatment groups without randomization, so differences in how patients were selected for each treatment could affect the results.
    Limitations
    Retrospective design comparing non-randomized groups; no information given on confounding factors or how treatment assignment was decided.

    Taken word for word from the abstract

    • n A total of 457 patients managed for first-time PA and/or FIA were eligible for the current study.
    • population A study of pediatric patients with first-time PA and/or FIA was conducted retrospectively
    • 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 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

    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

    Fistula common after abscess drainage.RetrospectiveLow qualityRelated question

    303 people119.7 months

    About half of patients had recurrence and 40% developed a fistula

    Who was studied
    patients who had emergency drainage of an anal abscess
    What they received
    urgent drainage and debridement of the abscess
    Compared with
    none (single cohort followed over time)
    Main outcome
    rate of recurrence and development of fistula after abscess drainage
    Quality
    This is a retrospective, single-cohort study without a comparison group, so it describes what happens after drainage rather than testing a way to prevent fistula.
    Limitations
    Retrospective design, no comparator group or tested preventive intervention, reliance on ultrasound and symptom review which may miss or overcall fistula.

    Taken word for word from the abstract

    • n All patients (n = 303) were evaluated two months and one year after the intervention.
    • population anal abscess of cryptoglandular origin
    • intervention drainage and urgent debridement of an anal abscess
    • comparator Retrospective observational study of a prospective cohort
    • primaryOutcome 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%.

    Cir Esp (Engl Ed) · PMID 34876366 · 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

    Fewer fistulas with seton drainage.Meta-analysisLow quality

    size not given2021

    incision-seton drainage had higher cure rates, shorter healing time, lower pain and continence scores, lower fistula formation and recurrence rates, fewer adverse events, and shorter hospital stay than incision-drainage alone

    Who was studied
    people with high perianal abscess
    What they received
    incision and seton drainage surgery
    Compared with
    incision and drainage surgery alone
    Main outcome
    cure rate, wound healing time, fistula formation, abscess recurrence, and complications
    Quality
    it pools multiple small trials of unclear individual quality and the authors themselves say there are gaps in the evidence and more high-quality trials are needed
    Limitations
    the abstract notes the meta-analysis still leaves gaps in the evidence and calls for more large-sample, high-quality, multi-center RCTs

    Taken word for word from the abstract

    • population 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).
    • limitations the results of this meta-analysis still leave some gaps in the evidence. More large-sample, high-quality, and multi-center RCTs are needed.

    Ann Palliat Med · PMID 34628909 · Read it on PubMed ↗

  • Hasan et al. 2023

    Incidence of anal fistula after pyogenic perianal abscess drainage in Kingdom of Bahrain

    About a third developed fistula.RetrospectiveLow qualityRelated question

    109 people2023

    About 1 in 3 patients developed a fistula after abscess drainage

    Who was studied
    adults diagnosed with perianal abscess in Bahrain
    What they received
    abscess drainage
    Main outcome
    development of anal fistula after abscess drainage
    Quality
    This is a retrospective study without a comparison group, so it cannot show whether anything prevents fistula formation.
    Limitations
    Retrospective design; data partly collected via phone calls; no comparison of preventive interventions.

    Taken word for word from the abstract

    • n A total of 109 patients with a diagnosis of anal abscess were included between 2015 and 2018.
    • population patients with a diagnosis of anal abscess
    • intervention A fistula developed following abscess drainage in 33.9% of patients.
    • primaryOutcome A fistula developed following abscess drainage in 33.9% of patients.
    • result The incidence of anal fistula in Bahrain after perianal abscess was 33.9%.

    Ann Coloproctol · PMID 34376025 · Read it on PubMed ↗

  • Arroyo-Martinez et al. 2020

    Urgent care practice in anorectal abscess. Still a pending task

    No clear way found to prevent fistula.RetrospectiveLow qualityRelated question

    190 people2020

    the only factor linked to recurrence was having an associated anal fistula, and antibiotics or referral practices showed no clear effect on recurrence

    Who was studied
    adults who had surgery for anorectal abscess in the emergency department
    What they received
    different emergency department treatments (drainage, antibiotics, referral to specialist clinic)
    Compared with
    no formal comparison group - treatments and outcomes compared across patients
    Main outcome
    recurrence of the abscess
    Quality
    this is a retrospective, single-center study without a controlled comparison, so it cannot show whether any treatment actually prevents fistula formation.
    Limitations
    retrospective design, single center, great variability in treatment practices, no randomization or control group

    Taken word for word from the abstract

    • 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.
    • comparator this was retrospective and unicentric study.
    • 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 without clear impact of any of them on the recurrence of the abscess.

    Cir Cir · PMID 33254180 · Read it on PubMed ↗

  • Rho et al. 2021

    Ligasure Hemorrhoidectomy: Updates on Complications After an 18-Year Experience

    Very low fistula rate after surgeryCase seriesVery low qualityRelated question

    1,454 people2021

    anal fistula occurred in 0.2% of patients as a long-term complication after this hemorrhoid surgery

    Who was studied
    adults with grade III and IV hemorrhoids undergoing surgery
    What they received
    LigaSure hemorrhoidectomy (a sealing-device hemorrhoid removal surgery)
    Compared with
    none - single group followed over time
    Main outcome
    rate of post-operative complications including anal fistula, stenosis, bleeding, and recurrence
    Quality
    this is a single-center descriptive case series with no comparison group, so it cannot show whether anything actually prevents fistula formation.
    Limitations
    no control group, not designed to test fistula prevention, single center, descriptive only

    Taken word for word from the abstract

    • n 1454 consecutive patients, treated with LH for grade III and IV hemorrhoids, were analyzed
    • population 1454 consecutive patients, treated with LH for grade III and IV hemorrhoids
    • intervention LigaSureTM hemorrhoidectomy (LH)
    • comparator In this monocentric descriptive study, from June 2001 to February 2019, 1454 consecutive patients, treated with LH for grade III and IV hemorrhoids, were analyzed.
    • primaryOutcome evaluate the outcomes of LigaSureTM hemorrhoidectomy (LH) analyzing main post-operative complications rate
    • result anal fistula, soiling, perianal abscess, and recurrence were identified in 0.2%, 0.1%, 0.3%, and 4.8% of patients, respectively

    Rev Recent Clin Trials · PMID 33023436 · Read it on PubMed ↗

  • Gokce et al. 2020

    Can the risk of anal fistula development after perianal abscess drainage be reduced?

    Hospital wound care cut fistula risk.RetrospectiveLow quality

    size not given2020

    fistula formation was significantly lower in the in-hospital washing and dressing group than in the home sitz-bath group

    Who was studied
    patients who had a perianal abscess drained by surgery
    What they received
    in-hospital dressing changes with washing of the area until the abscess healed
    Compared with
    dressing changes at home with 10% povidone-iodine sitz baths
    Main outcome
    development of an anal fistula after abscess drainage
    Quality
    This was a retrospective chart review, not a randomized trial, so other differences between groups could explain the result.
    Limitations
    Retrospective review of records; authors state a large, prospective study is needed for confirmation.

    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 healed, some still got 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 less than 24 months old
    What they received
    treating the abscess without general anaesthesia (antibiotics, baths, needle draining, or local anaesthesia drainage)
    Compared with
    no direct comparison group; outcomes compared to historical use of general anaesthesia
    Main outcome
    how many infants ended up needing general anaesthesia after initial non-GA treatment
    Quality
    The review combines mostly retrospective studies with no randomized trials and no control group, so it cannot reliably show whether this approach prevents fistula formation.
    Limitations
    No randomized controlled trials, mostly retrospective cohort data, and a lack of standardized treatment or follow-up across studies.

    Taken word for word from the abstract

    • population infants less than 24 months old
    • intervention management of perianal abscesses without GA in infants less than 24 months old
    • comparator Historically, general anaesthesia (GA) has been used to facilitate incision and drainage, with or without exploration for a fistula-in-ano (FIA).
    • primaryOutcome The primary outcome was the number of patients requiring GA following initial management without GA.
    • 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.
    • n Nine studies, involving 1049 infants less than 24 months old met inclusion criteria.

    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

    No difference in fistula risk.Meta-analysisLow qualityRelated question

    485 peoplemaximum follow-up period

    no significant difference in fistula formation, recurrence, or need for repeat treatment between packing and no packing

    Who was studied
    patients with cutaneous abscess (including some with ano-rectal abscess) undergoing incision and drainage
    What they received
    incision and drainage without packing the abscess cavity
    Compared with
    incision and drainage with packing the abscess cavity
    Main outcome
    development of fistula-in-ano, abscess recurrence, and need for second intervention
    Quality
    Pooled trials were few and small, and the analysis itself says the results were inconclusive and subject to error.
    Limitations
    Trial sequential analysis showed the meta-analysis was not conclusive and recurrence results were subject to type 2 error

    Taken word for word from the abstract

    • n 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.
    • population all randomised controlled trials (RCTs) comparing incision and drainage of cutaneous abscess with and without packing
    • intervention incision and drainage of cutaneous abscess with and without packing of the abscess cavity
    • comparator packing of the abscess cavity
    • primaryOutcome Abscess recurrence at maximum follow-up period, need for second intervention, and 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.
    • limitations The Trial Sequential Analysis demonstrated that the meta-analysis was not conclusive, and the results for recurrence were subject to type 2 error.

    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 rarely cured abscess permanently.RetrospectiveLow qualityRelated question

    113 peoplea median 34 months (range, 3 to 145 months)

    Conservative treatment alone permanently worked in only 14 of 113 patients, with abscess size predicting failure; recurrence rates after surgery were similar whether surgery was done first or after failed conservative treatment

    Who was studied
    children under 14 with perianal abscesses
    What they received
    conservative (non-surgical) treatment of perianal abscess
    Compared with
    primary surgery for the abscess
    Main outcome
    whether treatment achieved permanent remission without recurrence or progression to fistula/surgery
    Quality
    This is a retrospective chart review without randomization, so differences between groups could be due to other factors, not just treatment choice.
    Limitations
    Retrospective design, no randomization, treatment choice not standardized, long variable follow-up for recurrence.

    Taken word for word from the abstract

    • 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).
    • result multivariate analysis demonstrated that only abscess size (odds ratio, 3.37; P=0.023) was significant
    • n Of the 113 enrolled patients
    • followUp a median 34 months (range, 3 to 145 months)

    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 abscess recurrences with seton treatment.Prospective cohortLow qualityRelated question

    44 people12 months

    No abscess recurrence after drainage plus loose seton or fistulotomy, versus 58.8% recurrence after drainage alone (p<0.0001), with similar continence scores before and after surgery

    Who was studied
    patients with anorectal abscesses, some with possible fistula tracts
    What they received
    abscess drainage plus loose seton (or fistulotomy) for the fistula tract at the same operation
    Compared with
    abscess drainage alone
    Main outcome
    recurrence of anorectal abscess at 12 months, plus continence and complications
    Quality
    This was a small, non-randomized pilot study without blinding, so the results are not strong enough to be fully trusted.
    Limitations
    Pilot study design, not randomized, small group sizes, and the primary outcome was abscess recurrence rather than fistula formation itself.

    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.
    • intervention a loose seton was placed through the tract
    • comparator Drainage only was carried out in 17 patients.
    • 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.
    • 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).
    • followUp follow-up of 12 months

    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?

    Early fistulotomy prevented recurrence.RetrospectiveLow quality

    24 people2020

    No fecal incontinence or recurrence of perianal abscess were observed in any of our patients after fistulotomy, whereas the minimally invasive approach was associated with a high recurrence rate

    Who was studied
    infants and children with perianal abscess
    What they received
    fistulotomy (surgically opening the fistula) after identifying the fistula during abscess surgery
    Compared with
    minimally invasive treatment with sitz baths, antibiotics, and incision and drainage of the abscess
    Main outcome
    recurrence of perianal abscess or fistula, and fecal incontinence
    Quality
    This was a small, retrospective study of only 24 children without randomization, so the findings are not strong evidence.
    Limitations
    Retrospective design, small sample size, and no control group treated with only minimally invasive methods within the same study for direct comparison.

    Taken word for word from the abstract

    • n The retrospective study included 24 infants with perianal abscess treated at our center between 2013 and 2015.
    • population Perianal abscess and fistula-in-ano are common findings in infants and children.
    • 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.

    Pol Przegl Chir · PMID 32312918 · Read it on PubMed ↗

  • Amato et al. 2020

    Evaluation and management of perianal abscess and anal fistula: SICCR position statement

    No specific prevention finding reported.GuidelineLow qualityRelated question

    size not given2020

    the abstract does not report a specific quantitative result, it reviews literature to provide recommendations

    Who was studied
    people with perianal abscess or anal fistula
    What they received
    surgical treatment approaches for perianal sepsis
    Compared with
    different surgical procedures compared to each other
    Main outcome
    recurrence and continence problems after treatment
    Quality
    this is a narrative position statement summarizing literature rather than presenting new study data.
    Limitations
    no specific data, methods, or outcomes are reported in the abstract; it is a review-based position statement

    Taken word for word from the abstract

    • population Perianal sepsis is a common condition ranging from acute abscess to chronic anal fistula.
    • intervention Surgery is the main treatment and several procedures have been developed
    • comparator several procedures have been developed
    • 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 ↗

  • Lu et al. 2019

    Relationship Between Body Mass Index and Recurrence/Anal Fistula Formation Following Initial Operation for Anorectal Abscess

    Higher BMI linked to more recurrence.RetrospectiveLow qualityRelated question

    790 people27 (range, 1-38) months

    patients with higher BMI had a higher risk of recurrence than those with lower BMI

    Who was studied
    patients who had surgery for anorectal abscess
    What they received
    higher body mass index (BMI 26.0-40.6 kg/m²)
    Compared with
    lower body mass index (BMI 15.7-22.8 kg/m²)
    Main outcome
    recurrence of anorectal abscess or anal fistula formation after surgery
    Quality
    this is a retrospective single-center study without randomization, so it can show a link but not prove that higher BMI causes recurrence.
    Limitations
    retrospective, single-hospital registry design; no mention of controlling for other confounders beyond the stated adjusted model

    Taken word for word from the abstract

    • n A total of 790 patients were operated on during the study period.
    • population Patients treated for anorectal abscess from 01/2015 to 03/2016 were included.
    • intervention high BMI (range, 26.0-40.6 kg/m²) patients
    • comparator low BMI (range, 15.7-22.8 kg/m²) patients
    • primaryOutcome anorectal abscess recurrence or anal fistula formation following initial surgery
    • result high BMI (range, 26.0-40.6 kg/m²) patients showed higher risk of recurrence (HR=1.75, 95% CI: 1.15-2.67)
    • followUp Median follow-up was 27 (range, 1-38) months.

    Med Sci Monit · PMID 31642447 · Read it on PubMed ↗

  • Samuk et al. 2019

    Perianal abscess in infants: Amenable to conservative treatment in selected cases

    Conservative care often avoided surgery.RetrospectiveLow qualityRelated question

    19 people22.4 months

    13 of 17 followed patients avoided surgery; one patient developed fistula-in-ano that healed on its own

    Who was studied
    infants under 24 months with perianal abscess
    What they received
    conservative management (antibiotics without surgery) for selected perianal abscess cases
    Compared with
    surgical drainage (historical/standard approach)
    Main outcome
    need for surgical intervention and abscess/fistula recurrence
    Quality
    This was a small, retrospective study of only 19 infants without a comparison group, so it can't reliably show whether this approach prevents fistulas.
    Limitations
    Retrospective design, small sample size, no control group, two 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
    • population Data of 19 patients aged <24 months treated conservatively for perianal abscess at a tertiary hospital
    • intervention The aim of this study was to evaluate the outcomes of conservative approach in selected cases of perianal abscesses in infants.
    • comparator the most frequent approach is drainage with/without fistulotomy
    • primaryOutcome Thus, surgical intervention was prevented in 13/17 patients (76.4%) available for follow up.
    • result 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
    • followUp During follow up (mean, 22.4 months)

    Pediatr Int · PMID 31469939 · 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

    Lower rate of fistula formation with antibiotics (16% vs 24%), statistically significant on pooled analysis

    Who was studied
    patients who had surgical drainage of an anorectal abscess
    What they received
    antibiotics after drainage
    Compared with
    no antibiotics after drainage
    Main outcome
    developing an anal fistula afterward
    Quality
    Based on pooling only three studies with low-quality evidence, as stated by the authors themselves.
    Limitations
    Quality of evidence is low; only three studies contributed to the pooled odds ratio; antibiotic regimens varied; authors call for further randomized trials.

    Taken word for word from the abstract

    • n A total of six studies with 817 patients were included for systematic review.
    • population following incision and drainage of anorectal abscesses
    • intervention 459 (56.2%) patients were treated with antibiotics
    • comparator 358 (43.8%) underwent management without antibiotics
    • primaryOutcome to 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).
    • 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 ↗

  • Gong et al. 2018

    Treatment of First-Time Perianal Abscess in Childhood, Balance Recurrence and Fistula Formation Rate with Medical Intervention

    Less fistula with conservative treatment.RetrospectiveLow quality

    697 people395 days

    conservative treatment had a lower rate of recurrence/fistula (12.7%) than incision and drainage (24.6%)

    Who was studied
    children with their first perianal abscess
    What they received
    conservative (non-surgical) treatment of the abscess
    Compared with
    incision and drainage surgery
    Main outcome
    recurrence and/or fistula formation rate
    Quality
    This is a retrospective study without randomization, so treatment choice could be biased by abscess severity.
    Limitations
    Retrospective design; not randomized; treatment assignment not controlled

    Taken word for word from the abstract

    • n A total of 697 patients with first-time perianal abscess were included in this study.
    • population patients with first-time perianal abscess
    • intervention 355 (50.9%) patients who received conservative treatment
    • comparator abscesses treated with ID (24.6%, 72/297; p < 0.001)
    • primaryOutcome a wide range of recurrences and/or development of fistula-in-ano (RF) rates have been reported
    • result 355 (50.9%) patients who received conservative treatment had 12.7% (45/355) RF rate, which is less than that of abscesses treated with ID (24.6%, 72/297; p < 0.001).
    • followUp The median follow-up period was 395 days (range: 120-760 days).

    Eur J Pediatr Surg · PMID 28564707 · Read it on PubMed ↗

  • Shtyrkova et al. 2016

    [Perianal infection in patients with hemoblastosis: Risk factors and possibilities of prevention]

    Surgery lowered infection recurrence risk.Prospective cohortLow qualityRelated question

    72 people2016

    surgically treated patients had a 5 times lower risk of perianal complications than medically treated patients

    Who was studied
    patients with hemoblastosis
    What they received
    surgical treatment for anal fissures and fistulas performed between chemotherapy cycles
    Compared with
    patients treated medically (without surgery) for anal canal disease
    Main outcome
    risk of complications and recurrence of perianal infection during continued chemotherapy
    Quality
    This was a small, non-randomized prospective study in a very specific cancer population, so the findings may not generalize.
    Limitations
    Not randomized; small subgroup (29 patients) underwent surgery; population limited to hematologic cancer patients during chemotherapy.

    Taken word for word from the abstract

    • n The prospective study enrolled 72 patients (37 men and 35 women; mean age, 47 years) with hemoblastosis
    • population with hemoblastosis
    • intervention 29 patients were operated on for anal fissures and fistulas at intercycle intervals
    • comparator 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
    • primaryOutcome the risk of complications associated with abnormalities in the perianal area during continued CT
    • result 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)

    Ter Arkh · PMID 27459618 · Read it on PubMed ↗

  • Xu et al. 2016

    Bacteriological study in perianal abscess is not useful and not cost-effective

    Culture testing didn't predict fistula risk.RetrospectiveLow qualityRelated question

    164 people1450 (14-2391) days

    presence of gut organisms was not significantly linked to developing a fistula or abscess recurrence

    Who was studied
    patients who had surgery to drain a perianal abscess
    What they received
    bacterial culture testing of pus from the abscess
    Compared with
    no culture testing / comparing gut organisms vs skin organisms vs no growth
    Main outcome
    development of anal fistula or recurrence of abscess
    Quality
    This was a retrospective study without randomization, so it can show an association but not prove prevention.
    Limitations
    Retrospective design; abstract does not describe how confounders were handled.

    Taken word for word from the abstract

    • n A total of 164 patients
    • population patients who have had a surgical drainage of their perianal abscesses with concomitant microbiological examination
    • intervention The detection of gut organisms in perianal abscesses has been postulated to suggest an underlying communication with the anal canal
    • comparator Gut organisms were cultured in 143 (87.2%) samples while 12 (7.3%) demonstrated skin organisms and nine did not yield any bacterial growth (5.5%)
    • 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)
    • followUp The median follow-up period was 1450 (14-2391) days

    ANZ J Surg · PMID 27226422 · Read it on PubMed ↗

  • Pearce et al. 2016

    Multicentre observational study of outcomes after drainage of acute perianal abscess

    Packing didn't prevent fistula, just pain.Prospective cohortLow qualityRelated question

    141 people6 months

    about a quarter of patients developed a fistula within 6 months, and wound packing caused repeated pain without clear benefit

    Who was studied
    adults with an acute perianal abscess treated with surgical drainage
    What they received
    standard postoperative wound packing (dressing changes) after abscess drainage
    Compared with
    no control group; outcomes of usual care were observed without comparison
    Main outcome
    development of a fistula in ano and wound healing after abscess drainage
    Quality
    this was an observational study with no comparison group, so it cannot show whether packing or any other step actually changes the chance of a fistula forming.
    Limitations
    no control group for comparison, observational design, and the abstract notes limited evidence for the value of wound packing itself

    Taken word for word from the abstract

    • population Patients were recruited in 15 UK centres between December 2013 and October 2014.
    • 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.
    • comparator The evidence for postoperative wound packing is limited
    • 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 Patients reported a twofold to threefold increase in pain scores during and after dressing changes.
    • n Some 141 patients were recruited (median age 39 (range 18-86) years).
    • followUp developed a fistula in ano by 6 months following surgery

    Br J Surg · PMID 27061287 · Read it on PubMed ↗

  • Kroesen 2015

    [Special surgical complications in chronic inflammatory bowel diseases]

    Fat-pad surgery may prevent pelvic infection.Narrative reviewVery low quality

    size not given2015

    pelvic sepsis can be prevented by omentoplasty with pelvic fixation; other techniques help manage persisting sepsis and fistula recurrence

    Who was studied
    people with chronic inflammatory bowel disease having colorectal or anorectal surgery
    What they received
    omentoplasty with fixation inside the pelvis, and other surgical techniques like gracilis muscle transposition or seton drainage
    Compared with
    not reported
    Main outcome
    prevention or treatment of pelvic sepsis and anal fistula complications
    Quality
    this is a narrative review describing surgical techniques without study data, numbers, or comparison groups to support effectiveness claims
    Limitations
    no study design details, no patient numbers, no comparator group, and no statistical results are given for the specific claim about preventing fistula or sepsis

    Taken word for word from the abstract

    • population After colorectal and anorectal interventions for chronic inflammatory bowel diseases, specific complications can occur.
    • intervention Pelvic sepsis can be prevented by omentoplasty with fixation inside the pelvis.
    • primaryOutcome Pelvic sepsis can be prevented by omentoplasty with fixation inside the pelvis.
    • result Pelvic sepsis can be prevented by omentoplasty with fixation inside the pelvis.
    • comparator A persisting sepsis of the sacral cavity can be treated primarily by dissection of the anal sphincter which ensures better drainage.

    Chirurg · PMID 25693779 · 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 recurrence.Case seriesVery low qualityRelated question

    13 peoplemedian 61 months

    only patients whose fistula was not treated after drainage had a recurrence of anal infection

    Who was studied
    patients with abscess from anal gland infection located above the pelvic floor muscles
    What they received
    MRI-guided drainage followed by subsequent surgical treatment of the fistula
    Compared with
    no subsequent treatment of the fistula
    Main outcome
    recurrence of anal infection (fistula) over long-term follow-up
    Quality
    This is a small retrospective case series of only 13 patients without a control group, so it cannot reliably prove cause and effect.
    Limitations
    Retrospective design, small sample size, no comparison group, single center.

    Taken word for word from the abstract

    • n A retrospective case series including thirteen consecutive patients with cryptoglandular supralevator abscess treated between 2001 and 2011
    • population thirteen consecutive patients with cryptoglandular supralevator abscess
    • intervention Subsequent treatment of the fistula is necessary to avoid recurrence.
    • comparator only patients with supralevator abscess of ischiorectal origin in whom fistula was not subsequently treated presented a recurrence of the anal sepsis
    • primaryOutcome long-term results after drainage were also evaluated
    • result only patients with supralevator abscess of ischiorectal origin in whom fistula was not subsequently treated presented a recurrence of the anal sepsis

    Int J Colorectal Dis · PMID 25339133 · Read it on PubMed ↗

  • Bakari et al. 2013

    Fistula-in-Ano Complicated by Fournier's Gangrene Our Experience in North-Eastern Region of Nigeria

    Early treatment may prevent severe infection complication.Case seriesVery low qualityRelated question

    10 people2013

    early antibiotics and primary surgery were associated with prevention of the gangrene complication, while inadequate or delayed drainage was linked to its development

    Who was studied
    men with anal fistula complicated by a severe genital infection (Fournier's gangrene)
    What they received
    early antibiotics and surgical treatment (fistulotomy, seton placement, or flap surgery) for perianal abscess/fistula
    Compared with
    delayed or inadequate drainage of the abscess
    Main outcome
    development of Fournier's gangrene as a complication of fistula-in-ano
    Quality
    this is a small retrospective case series of only 10 patients with no comparison group, so it cannot reliably show what prevents anything.
    Limitations
    Retrospective case review of a small number of patients, no control group, and it studies prevention of a complication (Fournier's gangrene) arising from existing fistula-in-ano rather than prevention of fistula formation itself.

    Taken word for word from the abstract

    • n A total of 10 men with a mean age of 50.5 years (35-60) were managed in the period of study.
    • population Fistula-in-ano when complicated by Fournier's gangrene is an unusual finding and always carries high morbidity.
    • intervention Early broad spectrum parenteral antibiotic therapy and primary surgical treatment can prevent Fournier's gangrene.
    • comparator 4 (40%) of these patients had inadequate drainage of their perianal abscess and 2 (20%) had incision and drainage.
    • primaryOutcome if poorly managed results in Fournier's gangrene
    • 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 ↗

  • Abcarian 2011

    Anorectal infection: abscess-fistula

    Early drainage may limit fistula risk.Narrative reviewVery low qualityRelated question

    size not given2011

    abscesses lead to fistulas in about 40% of cases; conservative, nonsphincter cutting procedures have more recurrence/persistence than sphincter-cutting procedures, which carry incontinence risk

    Who was studied
    adults with anorectal abscess or fistula
    What they received
    early adequate drainage of abscess; various fistula treatments including fistulotomy, setons, fibrin sealant, anal fistula plug, flaps, and LIFT procedure
    Compared with
    different surgical approaches compared to each other (sphincter-cutting vs conservative, nonsphincter cutting techniques)
    Main outcome
    fistula formation, incontinence, and recurrence/persistence after treatment
    Quality
    This is a general narrative review summarizing existing knowledge without original data, a defined study population, or systematic methodology.
    Limitations
    No original study data, sample size, or systematic review methodology; general overview rather than a prevention trial.

    Taken word for word from the abstract

    • population Anorectal abscess and fistula are among the most common diseases encountered in adults.
    • intervention The treatment of an anorectal abscess is early, adequate, dependent drainage.
    • intervention draining seton, fibrin sealant, anal fistula plug, endorectal advancement flap, dermal island flap, anoplasty, and LIFT (ligation of intersphincteric fistula tract) procedure
    • comparator Primary fistulotomy and cutting setons have the same incidence of fecal incontinence depending on the complexity of the fistula.
    • primaryOutcome resulting in fistulas in ~40% of cases
    • result trading radical surgery for conservative (nonsphincter cutting) procedures such as a draining seton, fibrin sealant, anal fistula plug, endorectal advancement flap, dermal island flap, anoplasty, and LIFT (ligation of intersphincteric fistula tract) procedure all result in more recurrence/persistence requiring repeated operations in many cases

    Clin Colon Rectal Surg · PMID 22379401 · Read it on PubMed ↗

  • Afşarlar et al. 2011

    Perianal abscess and fistula-in-ano in children: clinical characteristic, management and outcome

    Antibiotics reduced fistula formation.RetrospectiveLow quality

    158 people10.6 ± 8.6 months

    antibiotics significantly reduced the development of fistula-in-ano

    Who was studied
    children treated for perianal abscess or fistula-in-ano
    What they received
    antibiotic therapy after abscess drainage
    Compared with
    drainage without antibiotics
    Main outcome
    development of fistula-in-ano
    Quality
    This was a retrospective chart review without randomization, so other factors could explain the difference.
    Limitations
    Retrospective design, no randomization, and treatment choices were not standardized.

    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 children with perianal abscess and fistula-in-ano
    • intervention Usage of antibiotics significantly reduced the development of fistula-in-ano (p = 0.001)
    • comparator did not effect the recurrence of perianal abscess (p > 0.05)
    • 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

    Faster healing, few recurrencesCase seriesVery low qualityRelated question

    9 people14.1 ± 3.2 months

    all patients improved, with pus and swelling resolving in about a week, and most had no recurrence over roughly 14 months

    Who was studied
    infant boys with perianal abscess
    What they received
    bFGF spray applied to the abscess
    Compared with
    none
    Main outcome
    resolution of pus discharge and swelling, and recurrence
    Quality
    This was a very small study of only nine patients with no comparison group, so it can't reliably show whether the treatment actually works.
    Limitations
    small sample size, no control group, no randomization

    Taken word for word from the abstract

    • n Nine consecutive males with an average age of 5.1 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 PATIENTS AND METHODS: Nine consecutive males with an average age of 5.1 months (1-9 months) who presented with perianal abscess in the past 2 years were treated with bFGF
    • primaryOutcome Pus discharge and local swelling around the fistula subsided within a mean of 7.3 ± 1.9 days
    • result All nine patients responded well to the bFGF treatment.
    • 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 ↗

  • Hamadani et al. 2009

    Who is at risk for developing chronic anal fistula or recurrent anal sepsis after initial perianal abscess?

    Antibiotics did not prevent recurrence.RetrospectiveLow qualityRelated question

    148 people38 months

    younger age (<40) increased recurrence risk; diabetics had lower risk; antibiotics, smoking, gender, and HIV status made no significant difference

    Who was studied
    patients with a first-time perianal abscess
    What they received
    no specific intervention; study examined risk factors (age, diabetes, antibiotics, smoking, HIV status)
    Compared with
    patients without each risk factor (e.g., age ≥40, diabetics, non-smokers)
    Main outcome
    developing chronic anal fistula or recurrent anal sepsis
    Quality
    This was a retrospective study without randomization, so it can show patterns but not prove what prevents fistulas.
    Limitations
    Retrospective cohort design; cannot establish causation, only associations with recurrence risk.

    Taken word for word from the abstract

    • n One hundred and forty-eight patients met inclusion criteria
    • population patients with a first-time perianal abscess who were treated at Kaiser Permanente Los Angeles between 1995 and 2007
    • intervention perioperative antibiotics vs. no antibiotics
    • comparator nondiabetics were 2.69 times as likely to experience recurrence as diabetics
    • primaryOutcome chronic anal fistula or recurrent sepsis after initial perianal abscess
    • result Age younger than 40 years significantly increased risk of chronic anal fistula or recurrent anal sepsis after a first-time episode of perianal abscess. Patients with diabetes may have a decreased risk compared with nondiabetic patients. 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 ↗

  • Serour et al. 2005

    Perianal abscess and fistula-in-ano in infants: a different entity?

    Antibiotics after drainage reduced fistula risk.RetrospectiveLow qualityRelated question

    98 people2005

    fewer infants developed a fistula when given antibiotics after drainage (27.9%) compared with drainage alone (66.7%)

    Who was studied
    infants under 2 years old with perianal abscess or anal fistula
    What they received
    antibiotics given after draining the abscess
    Compared with
    drainage of the abscess alone without antibiotics
    Main outcome
    whether the infant later developed an anal fistula
    Quality
    This was a retrospective chart review in infants, not a randomized study, so other differences between groups could explain the result.
    Limitations
    Retrospective design, no randomization, and the study is in infants which may differ from the general population asking about fistula prevention.

    Taken word for word from the abstract

    • n The study included 98 infants.
    • population all infants younger than 24 months of age treated for perianal abscess, fistula-in-ano, or both
    • intervention Following drainage, 43 patients received antibiotics.
    • comparator Patients who received antibiotics following drainage were less likely to develop fistula-in-ano than were patients who underwent a drainage procedure alone
    • primaryOutcome Twenty-eight boys (36.4 percent) had an evolution toward fistula-in-ano.
    • result 27.9 percent vs. 66.7 percent, P < 0.05

    Dis Colon Rectum · PMID 15616754 · Read it on PubMed ↗

  • Barthés-Anidjar et al. 2003

    [Perianal abcess in infant]

    Drainage alone, no fistula developed.Case seriesVery low quality

    1 people2003

    no fistula found during surgery and no recurrence afterward

    Who was studied
    7-week-old baby boy with a perianal abscess
    What they received
    surgical drainage of the abscess
    Compared with
    no comparison group
    Main outcome
    whether a fistula formed or came back after treatment
    Quality
    this is a single infant case report, so it cannot reliably show what prevents fistula formation in general.
    Limitations
    only one patient reported, no comparison group, and the abstract notes a congenital or hormonal cause is only suspected, not proven.

    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.
    • intervention The infant was admitted to the surgical center to undergo a perianal abcess drainage.
    • comparator During the intervention, no fistula was found.
    • primaryOutcome No recurrence was observed.
    • result During the intervention, no fistula was found. No recurrence was observed.
    • n A 7-week-old boy had a painful swollen perianal lesion

    Ann Dermatol Venereol · PMID 12746675 · Read it on PubMed ↗

  • Murthi et al. 2002

    Perianal abscess in childhood

    Fistulotomy at drainage prevented fistula recurrence.RetrospectiveLow quality

    33 people2002

    no recurrences occurred when fistulotomy was done at the same time as drainage, while all recurrences occurred in children treated by drainage alone

    Who was studied
    children with perianal abscess
    What they received
    fistulotomy (laying open a fistula tract) performed at the same time as initial abscess drainage
    Compared with
    incision and drainage of the abscess alone
    Main outcome
    recurrence as fistula-in-ano or repeat perianal abscess
    Quality
    this was a small retrospective chart review without randomization, so other factors could explain the difference
    Limitations
    retrospective design, small sample size, not randomized

    Taken word for word from the abstract

    • n Thirty-three cases were identified (29 boys and 4 girls).
    • population the case notes of all children who presented to our institution with a PA between January 1992 and January 1997 were reviewed retrospectively.
    • intervention A fistulous tract was identified and laid open at the time of primary drainage in 20 cases
    • comparator whilst 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 ↗

  • Rosen et al. 2000

    The nonoperative management of fistula-in-ano

    Fistulas healed without surgery.Case seriesLow qualityRelated question

    18 peopleMean follow-up period was 37 months

    77% of infants developed fistulas, and all of these healed without any operation; no antibiotics were needed

    Who was studied
    male infants with perianal abscess or fistula
    What they received
    conservative, nonoperative management (observation, drainage only if uncomfortable or feverish)
    Compared with
    standard fistulotomy (surgical treatment), not directly tested in this study
    Main outcome
    whether fistulas healed without surgery
    Quality
    This is a small, single-arm study of only 18 infants with no comparison group, so it can't firmly prove conservative care is better than surgery.
    Limitations
    Small sample size, no control group, single-institution prospective case series.

    Taken word for word from the abstract

    • n A conservative approach to perianal abscess and fistula was used prospectively in 18 male infants.
    • population 18 male infants
    • intervention Abscesses were to be drained only if the baby was very uncomfortable or febrile.
    • comparator Fistulotomy is the accepted treatment for infants with perianal fistula.
    • primaryOutcome Once a fistula developed the authors continued observation until the fistula healed.
    • result Fistulas developed in 14 patients (77%). All fistulas healed without operation.
    • followUp Mean follow-up period was 37 months.

    J Pediatr Surg · PMID 10873039 · Read it on PubMed ↗

  • Knoefel et al. 2000

    The initial approach to anorectal abscesses: fistulotomy is safe and reduces the chance of recurrences

    Early fistulotomy cut recurrence, few incontinence issues.RetrospectiveLow quality

    131 people40 (range 3-78) months

    Doing fistulotomy at the same time as draining the abscess cut recurrence from 34% to 4%, and from 67% to 0% in patients having surgery for a recurrence; only 3% developed minor incontinence, and only after recurrent disease

    Who was studied
    people with an anal abscess or anal fistula
    What they received
    draining the abscess plus cutting open the fistula at the same time (fistulotomy)
    Compared with
    draining the abscess alone without treating the fistula
    Main outcome
    fistula or abscess coming back, and bowel control problems
    Quality
    This is a retrospective chart review, not a randomized trial, so other differences between patients could explain the results.
    Limitations
    Retrospective design with follow-up questionnaires, not a randomized comparison.

    Taken word for word from the abstract

    • population 158 patients with an anorectal abscess or anal fistula
    • intervention When fistulotomy was performed at the time of draining the abscess
    • comparator in comparison to incision and drainage alone
    • primaryOutcome 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
    • n The records and follow-up questionnaires of 131 patients were evaluable.
    • followUp The mean follow-up period was 40 (range 3-78) months.

    Dig Surg · PMID 10867462 · Read it on PubMed ↗

  • Festen et al. 1998

    Perianal abscess and fistula-in-ano in infants

    Drainage often leads to fistula.RetrospectiveLow quality

    size not given1 to 24 year, mean 7.74 year

    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

    Who was studied
    infants with perianal abscess or fistula-in-ano
    What they received
    simple drainage of perianal abscess, or fistulotomy/fistulectomy for fistula
    Main outcome
    development of fistula after abscess drainage, and recurrence after fistula surgery
    Quality
    This is a retrospective chart review with no comparison group and long-term follow-up relying on questionnaires, so the findings are not strong evidence for preventing fistulas.
    Limitations
    Retrospective design, follow-up based on questionnaire response of only 81%, no control group to compare treatments.

    Taken word for word from the abstract

    • population Perianal abscess and fistula-in-ano in infants
    • intervention Drainage of a perianal abscess
    • intervention Fistulotomy or fistulectomy
    • primaryOutcome The aim of this study was 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.
    • result 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

    Fewer recurrences with added fistula cutRetrospectiveLow qualityRelated question

    80 people44.3 months

    lower recurrence with combined treatment but similar continence problems

    Who was studied
    patients with ischiorectal abscess
    What they received
    incision and drainage plus fistulotomy at the same time
    Compared with
    incision and drainage alone
    Main outcome
    recurrence of abscess/fistula and change in bowel continence
    Quality
    This was a retrospective chart review without randomization, so other factors could explain the difference.
    Limitations
    Retrospective design, no randomization, no control for confounding factors, telephone follow-up for continence assessment.

    Taken word for word from the abstract

    • n retrospective review of 80 patients with IA
    • population 80 patients with IA managed from 1983 to 1996
    • intervention I&D and F
    • comparator I&D alone
    • primaryOutcome evaluation of recurrence rates and anal continence
    • result a 44 per cent recurrence rate in those who underwent I&D as compared with 21.1 per cent following I&D and F
    • followUp mean, 44.3 months

    Am Surg · PMID 9247434 · Read it on PubMed ↗

  • Nix et al. 1997

    Perianal sepsis in children

    Fistulectomy had fewer recurrences than fistulotomyCase seriesLow qualityRelated question

    58 people1997

    Fistula formation only occurred in children with enteric bacterial infection, and fistulectomy caused significantly fewer recurrences than fistulotomy

    Who was studied
    children with a perianal abscess or fistula
    What they received
    incision and drainage for abscess, with fistulectomy for fistula
    Compared with
    fistulotomy
    Main outcome
    development of an anal fistula after treatment and rate of recurrence
    Quality
    This is a small retrospective review of 58 children from one hospital, not a controlled study, so it cannot reliably prove what prevents fistula formation.
    Limitations
    Retrospective, single-centre case series without a control group or randomisation, and identifiable causes were rare apart from Crohn's disease.

    Taken word for word from the abstract

    • n A consecutive series of 58 children (51 boys, seven girls) with a perianal abscess or fistula attending a tertiary referral centre over a 4-year period was reviewed.
    • population Perianal sepsis is a relatively common surgical problem in children
    • intervention Abscess is best treated by incision and drainage, and fistulectomy is successful for the small proportion who develop a fistula.
    • comparator Of 24 children with a perianal fistula five required further surgery for recurrence, four of whom were initially treated by fistulotomy.
    • primaryOutcome the frequency of fistula formation complicating perianal abscess
    • result Fistula formation only occurred in those with enteric bacterial infection.
    • result treatment by fistulectomy resulted in significantly fewer recurrences

    Br J Surg · PMID 9189098 · Read it on PubMed ↗

  • Makowiec et al. 1997

    Perianal abscess in Crohn's disease

    Stoma cut abscess recurrence.Prospective cohortModerate qualityRelated question

    126 people32 +/- 17 months

    abscess recurrence was much lower in patients with a stoma (13% vs 60% without stoma) and in those with superficial fistulas; long-term seton use did not prevent recurrence

    Who was studied
    patients with perianal Crohn's disease
    What they received
    having a fecal diversion (stoma) and type of surgical drainage (seton, catheter, or incision)
    Compared with
    patients without a stoma and different anal fistula types
    Main outcome
    occurrence and recurrence of perianal abscess
    Quality
    it was a prospective observational study without randomization, so other factors could explain the differences seen.
    Limitations
    observational design without randomization; focuses on abscess recurrence in patients who already have perianal fistulizing Crohn's disease rather than preventing new fistula formation

    Taken word for word from the abstract

    • population 126 consecutive patients with perianal Crohn's disease seen regularly in an outpatient clinic
    • n Of 126 consecutive patients with perianal Crohn's disease
    • intervention Abscess recurrence was less frequent in patients with a stoma
    • comparator 13 vs. 60 percent in patients without stoma after two years
    • primaryOutcome we evaluated factors influencing the occurrence and recurrence of perianal abscesses
    • result Abscess recurrence was less frequent in patients with a stoma (13 vs. 60 percent in patients without stoma after two years) and in patients with superficial anal fistulas (0 vs. 55 percent/56 percent in patients with transsphincteric/ischiorectal fistulas).

    Dis Colon Rectum · PMID 9106694 · Read it on PubMed ↗

  • Schaarschmidt et al. 1997

    [Pyogenic periproctitis infections in childhood]

    Few developed fistulas after drainage.Case seriesVery low qualityRelated question

    128 people3 weeks and 3 years

    five children developed an anal fistula after deroofing of anal abscesses, and a quarter had a recurrence of abscess

    Who was studied
    children with pus-filled perianal (around-the-anus) infections
    What they received
    surgical drainage (deroofing) of anal abscesses
    Compared with
    not reported
    Main outcome
    development of an anal fistula after abscess treatment
    Quality
    This is a small, uncontrolled case series without any comparison group, so it can't show what actually prevents fistulas.
    Limitations
    No comparator group, no test of any preventive intervention; just observed outcomes after standard abscess drainage.

    Taken word for word from the abstract

    • n A total of 128 pediatric pyogenic perianal infections were recorded prospectively in 1984-1995
    • population A total of 128 pediatric pyogenic perianal infections were recorded prospectively in 1984-1995
    • intervention five children had an anal fistula after deroofing of anal abscesses
    • comparator five children had an anal fistula after 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.
    • followUp between 3 weeks and 3 years after the initial operation

    Langenbecks Arch Chir Suppl Kongressbd · PMID 9574424 · Read it on PubMed ↗

  • Georghiou et al. 1995

    Fistula-in-ano: an unusual presentation of chronic schistosomiasis

    Possible fistula prevention, not proven.Case seriesVery low qualityRelated question

    1 people1995

    the abstract only suggests that treatment may prevent further complications; it does not report an actual outcome of giving praziquantel

    Who was studied
    a 30 year old Ethiopian man with recurrent perianal abscess and fistula-in-ano caused by schistosomiasis
    What they received
    treatment of the schistosomiasis infection with the drug praziquantel
    Compared with
    no comparison group reported
    Main outcome
    whether treating the underlying schistosomiasis prevents further fistula complications
    Quality
    This is a single patient case report with no control group and no reported treatment outcome, so it carries very little weight.
    Limitations
    Single case report describing a rare parasitic cause of fistula-in-ano, with no data on whether treatment actually prevented recurrence or future fistula formation.

    Taken word for word from the abstract

    • n A 30 year old Ethiopian man presented with recurrent perianal abscess and fistula-in-ano.
    • population A 30 year old Ethiopian man presented with recurrent perianal abscess and fistula-in-ano. Ova of Schistosoma mansoni were found on fecal microscopy
    • intervention Treatment of schistosomiasis with praziquantel may prevent further complications of this condition.
    • comparator Treatment of schistosomiasis with praziquantel may prevent further complications of this condition.
    • primaryOutcome Treatment of schistosomiasis with praziquantel may prevent further complications of this condition.
    • result Treatment of schistosomiasis with praziquantel may prevent further complications of this condition.

    Aust N Z J Surg · PMID 7611980 · Read it on PubMed ↗

  • Schouten et al. 1987

    Primary partial internal sphincterectomy in the treatment of anorectal abscess

    No fistulas after added sphincter cut.Case seriesVery low quality

    74 people1987

    no recurrent abscesses or persistent fistulas occurred

    Who was studied
    patients with anorectal abscess
    What they received
    incision and drainage plus partial internal sphincterectomy
    Compared with
    none (compared to historical simple incision and drainage)
    Main outcome
    recurrence of abscess or development of chronic anal fistula
    Quality
    This is a small, uncontrolled case series without randomization or a comparison group, so it can't reliably show the procedure works.
    Limitations
    No control group, not randomized, no blinding, and no follow-up duration given.

    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
    • comparator Anorectal abscess is usually treated by simple 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 ↗

  • Vasilevsky et al. 1984

    The incidence of recurrent abscesses or fistula-in-ano following anorectal suppuration

    Fistula developed in about half.RetrospectiveLow qualityRelated question

    117 people1984

    48% of those with perianal or ischiorectal abscesses later developed a fistula or recurrent abscess, while none with intersphincteric abscesses did

    Who was studied
    patients who had incision and drainage for an anorectal abscess
    What they received
    incision and drainage of the abscess alone, without fistulotomy at the time
    Compared with
    no separate comparator group; outcomes tracked over time in the same patients
    Main outcome
    whether a recurrent abscess or fistula-in-ano developed afterward
    Quality
    this is a retrospective chart review without a comparison group, so it can show how often fistulas occur after drainage but cannot prove what prevents them.
    Limitations
    retrospective design, no control group, and no direct test of a preventive intervention like primary fistulotomy

    Taken word for word from the abstract

    • population 117 patients who underwent incision and drainage of anorectal abscesses
    • intervention incision and drainage of anorectal abscesses
    • comparator a retrospective study of 117 patients who underwent incision and drainage of anorectal abscesses was conducted to ascertain what percentage of patients would subsequently develop a fistula-in-ano or recurrent abscess
    • primaryOutcome what percentage of patients would subsequently develop a fistula-in-ano or recurrent abscess
    • result Of the 83 patients with perianal or ischiorectal abscesses, 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.
    • n 117 patients who underwent incision and drainage of anorectal abscesses

    Dis Colon Rectum · PMID 6697831 · Read it on PubMed ↗

  • Van Baal et al. 1981

    Peri-anal abscess--the relationship between peri-anal abscess, hepatitis B and sexual behavior

    Does not address fistula prevention.Case seriesVery low qualityRelated question

    22 people1981

    positive hepatitis B markers found only in male patients who reported frequent homosexual contact

    Who was studied
    patients with abscess or fistula around the anus
    What they received
    testing for hepatitis B markers (HBsAg and anti-HBs)
    Compared with
    no comparator
    Main outcome
    presence of hepatitis B virus markers and link to sexual behavior
    Quality
    This is a very small, uncontrolled observational study that does not test any method of preventing fistula formation.
    Limitations
    Small sample size, no control group, selective testing, and no assessment of fistula prevention methods.

    Taken word for word from the abstract

    • population Twenty-two patients with a peri-anal abscess or peri-anal fistula were studied selectively for the presence of HBsAg and anti-HBs.
    • n Twenty-two patients with a peri-anal abscess or peri-anal fistula were studied selectively
    • intervention studied selectively for the presence of HBsAg and anti-HBs
    • comparator In 14 male and 8 female patients studied, the incidence of anti-HBs was 6 and of HBsAg 1.
    • primaryOutcome the incidence of anti-HBs was 6 and of HBsAg 1
    • result Positive findings occurred only in European male patients who invariably showed frequent homosexual contacts.

    Neth J Surg · PMID 7231748 · Read it on PubMed ↗

  • Nazarov et al. 1980

    [Pathogenesis of postoperative complications of paraproctitis and measures for their prevention]

    Treating anal crypts may prevent fistulas.Case seriesVery low quality

    size not given1980

    treating the crypts during surgery reduced local complications and was seen as a way to prevent recurrent abscesses or fistulas

    Who was studied
    people having surgery for acute paraproctitis (anal gland abscess)
    What they received
    removing or treating the inflamed anal crypts (cryptotomy/cryptectomy) during the surgery
    Compared with
    no specific comparison group described
    Main outcome
    postoperative complications such as abscess recurrence or anal fistula
    Quality
    this is an old descriptive report without a clear control group or defined patient numbers, so it can't reliably prove cause and effect
    Limitations
    no total patient count given, no comparison group described, and no study design details provided

    Taken word for word from the abstract

    • population radical operations for paraproctitis
    • intervention Sanitation of Morgagni crypts (cryptotomy and cryptectomy) during radical operations for paraproctitis
    • comparator decreases the number of local postoperative complications
    • 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 ↗

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 2026-10-13
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 · 73 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.

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.

How we grade evidence →

  1. 140records came back from the search
  2. 139were read
  3. 73actually answered the question
Risks and safetyReported side effects and who should be careful.
  • In a rigorous placebo-controlled trial, people given antibiotics after drainage developed fistulas more often than those given placebo (37% vs 22%).
  • Needle aspiration of the abscess, instead of surgical incision, was linked to more abscesses coming back in one trial (41% vs 15%).
  • Packing the wound after drainage caused more pain than leaving it unpacked, with no added benefit in preventing fistula or recurrence.
Why people askWhat brings people to this question.
  • Antibiotics feel like a natural safeguard after any infection is drained, even though trials disagree about whether they actually help here.
  • Packing the wound or doing sitz baths feels like active self-care, giving people something to do during a slow, uncomfortable healing process.
  • People want to avoid a second operation, so techniques done right away, like a seton, can feel like insurance against needing more surgery later.
  • A less invasive option, like needle aspiration instead of a surgical cut, can feel appealing because it sounds gentler, even though it was less effective in a trial.
Common questionsShort answers, drawn from the same studies.
How can I prevent fistula recurrence?
If a fistula tract is already visible when the abscess is drained, treating it at the same time - for example with a seton - lowered recurrence in a randomised trial and a review of similar trials, compared with draining the abscess alone. If a fistula has already formed and been treated once, no study here specifically tested how to stop it coming back a second time.
How do I prevent a fistula after an abscess?
No single method reliably prevents this in every case. The clearest evidence relates to surgery itself: if a fistula tract is seen while draining the abscess, treating it then may lower later problems. Antibiotics are not a reliable answer - trials disagree, and the best-designed one found antibiotics were linked to more fistulas, not fewer.
Should I take antibiotics after my abscess is drained to stop a fistula forming?
Don't assume antibiotics will prevent a fistula. One well-conducted, placebo-controlled trial found antibiotics were linked to more fistulas forming, not fewer, while a different trial found the opposite. Talk to your surgeon about whether antibiotics are needed for your infection generally, rather than taking them specifically to prevent a fistula.
What should I do instead to lower my risk?
Ask your surgeon to check for a fistula tract at the time of your abscess drainage. If one is found, treating it in the same operation - for example with a seton - has the most consistent evidence for lowering the chance of it coming back, without a clear rise in bowel control problems in these trials.
Does packing the wound help prevent a fistula?
No. A randomised trial found packing the wound after drainage made no significant difference to fistula or recurrence rates, and caused more pain than leaving it unpacked.

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.

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