Treatment of Anorectal Abscess with Identified Anal Fistula: One-stage or Two-stage Operation

Background. Whether the underlying fistula of anorectal abscess should be treated when the abscess is drained remains controversial. Aretrospective chart review was undertaken to assess the treatment outcomes of fistulectomy in terms of the clinical parameters. Methods. We used a retrospective study to clarify whether primary fistu-lectomy can be performed in the management of patients with anorectal abscess with an identified anal fistula. The choice of the surgery was dependent on surgeon preference. One patient group underwent drainage and a primary fistulectomy and the other group underwent incision and drainage initially, followed by a secondary fistulectomy. The outcome variables analyzed were postoperative recurrence and persistence, anal function disturbance, wound-healing time, hospital stay, mean postoperative pain score, and complications. Results. Thirty-seven patients with an anorectal abscess with an identified anal fistula underwent incision and drainage with a primary fistulectomy (group Ⅰ), and 27 patients were treated with a two-stage fistulectomy (group Ⅱ). The operation times were 42.41 minutes for group I and 56.44 minutes for group Ⅱ, which are significantly different (p=0.004). There was no significant difference in the hospital stays, wound-healing times, mean postoperative pain scores, recurrences, postoperative complications of the two groups. Conclusion. Anorectal abscess with identified anal fistula can be managed with a one-stage operation, and this treatment did not differ from the two-stage operation. The one-stage operation required less time than the two-stage operation. Patients with anorectal abscess could try to locate the internal opening of the anal fistula, and underwent a one-stage operation of primary fistulectomy without another admission.