Treatment of Perianal Abscess with Fistula in Ano

Initial Management

The American College of Surgeons recommends surgical approach with incision and drainage as the definitive treatment for all anorectal abscesses, with the incision kept as close as possible to the anal verge to minimize the length of a potential fistula while providing adequate drainage 1
The World Journal of Emergency Surgery suggests that the timing of surgery should be based on the presence and severity of sepsis; patients with sepsis, immunosuppression, diabetes, or diffuse cellulitis require emergent drainage 1
In fit, immunocompetent patients with small perianal abscesses without systemic signs of sepsis, outpatient management can be considered, as recommended by the World Journal of Emergency Surgery 1

For fistulas involving sphincter muscle, the American Society of Colon and Rectal Surgeons recommends placing a loose draining seton rather than performing immediate fistulotomy to prevent incontinence 2

The risk of recurrence after drainage alone can be as high as 44%, emphasizing the need for complete and accurate drainage, according to the World Journal of Emergency Surgery 1

Inadequate drainage, loculations, horseshoe-type abscess, and delayed time from disease onset to incision are risk factors for recurrence, as reported by the World Journal of Emergency Surgery 1