Any abscesses around the anus can be changed into peri-anal fistulas. Approximately 10% of abscess recurrence occur thats why surgical follow-up is essential and 40% of them can be altered into fistula-in-ano depending upon the level of the fistula. not any specific preventive measures have been shown because of its unknown aetiology of origin.

I agree with the 40%.But last year especially in intersphincteric or in high ischiorectal abscesses we use petzer tube in order to keep the abscess cavity open we irrigate through it hypertonic saline, and take it out gradually in about one week.With this way we din't notice any remaining fistula.

I think about 10% of perianal abscesses at most persist as fistula in ago. As this is so low we never follow up abscesses and try not to pack where possible, asking patients to clean the wound each day with clean water - say in the shower - using a finger, which seems to be just as effective in encouraging healing from the base of the wound. Given the generally accepted pathogenesis of cryptogenic fistula, it is difficult to see how anything one would do superficially could decrease fistula formation.

At our center, we observed in a group of 203 cases of Perianal Abscess, only 6% cases recurred.(followup of 3 yrs),(interestingly almost all recurrences reported in first year of follow up). At the time of I & D proper curettage of floor and P.O. dressing minimize the recurrence.

Thank to the author for this interesting question!

The fact that the fistula aetiology is unknown is matter of special concern.

Dear colleagues, who knows about supravital methods of searching of the glandular tissue remnants in the perianal abscess cavity? Have attempts of this kind taken place whenever, wherever?

This is an interesting questions - as the percentage increases with time as recurrence occurs at any stage, and fistula often do not present to the original surgeon or hospital, so we probably under-estimate the total.

I believe 40% is understimate because you nevera know where patient go on recurrence or for fistula

To answer this question for sure, there should be a proctological database developed in the scales of the city or region. Does anyone has such experience, estimated colleagues?

According to literature, if E. coli is grown in culture from the perineal abscess, fistula will surely occur. The American Society of Colon & Rectal Surgeons estimate that about 50% of patiernts with perineal abscess will get fistulas.

Dr.Rangarajan, and what more benefit can grow up from a peineal abscess save the E.coli or its relatives (Eubacteriaceae), or obligate anaerobs, let me to ask, please?

Dear Dr.Borodach, the concept is that if Staph aureus is isolated from the pus , it is most likely a subcutaneous abscess in the peri-anal area. So fistula is unlikely in this case

Thank you for the answer,

Staphylococcus is quite rate on this remote region :) . Its natural locus is the outer nostrils epithelium, and it spread into the skin of the face and upper body. However, I would not claim that it is impossible, of course, it does sometimes, but seemingly it is very rare an event to find in the perineal abscess contents. So, it might be not statistically reliable difference between the huge amount of E.coli invested abscesses and much fewer of the Staph.-associated. I would be obliged if you share your own data on this matter.

In my practice, I culture all cases of perineal abscess, and if E. coli is grown, I tell the patients that fistula is highly likely.

Reference: Elsevier Saunders Publisher; A Companion to Specialist Surgical Practice; Colorectal Surgery; 3rd Volume; Edited by Robin K. S. Phillips; Chapter 13; Page 244

Results of a multicentre observational study published in BJS shows that 26·7% of patients developed a fistula in ano by 6 months following surgery. It also shows that packing is painful and costly.

Article Multicentre observational study of outcomes after drainage o...

• This recent article published in BJS [Sahnan, K., Askari, A., Adegbola, S. O., Tozer, P. J., Phillips, R. K. S., Hart, A. and Faiz, O. D. (2017), Natural history of anorectal sepsis. Br J Surg, 104: 1857–1865.], an observational population-based study shows that approximately one-fifth of all patients with an anorectal abscess develop a fistula. And majority of fistulas occurred within the first year of the preceding abscess and this was most pronounced in patients with Crohn’s disease. Nearly half of all patients with Crohn’s abscesses developed a fistula.