Factors influencing fistula formation following perianal abscess treatment

Year 2025, Volume: 11 Issue: 4, 794 - 799, 04.07.2025

Amil Huseynov , Sevim Nuran Kuşlu Çiçek

https://doi.org/10.18621/eurj.1678608

Abstract

Objectives: Perianal abscesses are frequently encountered in clinical practice and are primarily attributed to a cryptoglandular origin. Despite prompt incision and drainage, a subset of patients still develop anal fistulas. This study aims to identify risk factors associated with fistula formation after perianal abscess management.

Methods: A total of 145 patients (64 females, 81 males) with perianal abscess were retrospectively reviewed between 2020 and 2024. All underwent urgent incision and drainage under anesthesia. Demographic characteristics, comorbidities, type of surgical intervention, and postoperative outcomes were analyzed. Postoperative complications were assessed at both early (≤30 days) and late (>30 days) time points. Univariate and logistic regression analyses were conducted to determine independent predictors of fistula formation.

Results: The median patient age was 42 years (IQR: 35-50), and 37.9% had at least one comorbidity (17.2% diabetes mellitus, 13.8% hypertension). Intraoperative fistulas were identified in 37.9% of cases and managed via fistulotomy or seton placement when feasible. Early postoperative complications occurred in 24.1% of patients, most of which were minor. Over a median follow-up of 7 months (IQR: 4-12), abscess recurrence was observed in 6.9% and new-onset fistula in 14.5%. Comorbidities such as diabetes mellitus were associated with a higher likelihood of fistula formation. Anal incontinence was documented in 2.8% of patients, most cases resolving spontaneously or with conservative measures.

Conclusions: Although urgent incision and drainage generally yields favorable early outcomes, a notable proportion of patients develop late complications, particularly fistula formation. Close follow-up and tailored surgical strategies, including fistulotomy or seton placement when indicated, may help reduce morbidity. Prospective and multicenter studies with extended follow-up are warranted to further refine treatment protocols and identify high-risk individuals.

Keywords

Perianal abscess , anal fistula , fistulotomy , seton placement , postoperative complications , cryptoglandular disease

Ethical Statement

This study was approved by the Biruni University Scientific Research Ethics Committee (Decision no.: 2024-BİAEK/06-50, date: 20.01.2025).

References

• 1. Steele SR, Kumar R, Feingold DL, Rafferty JL, Buie WD; Standards Practice Task Force of the American Society of Colon and Rectal Surgeons. Practice parameters for the management of perianal abscess and fistula-in-ano. Dis Colon Rectum. 2011;54(12):1465-1474. doi: 10.1097/DCR.0b013e31823122b3.
• 2. Parks AG, Gordon PH, Hardcastle JD. A classification of fistula-in-ano. Br J Surg. 1976;63(1):1-12. doi: 10.1002/bjs.1800630102.
• 3. Sarofim M, Ooi K. Reviewing perianal abscess management and recurrence: lessons from a trainee perspective. ANZ J Surg. 2022;92(7-8):1781-1783. doi: 10.1111/ans.17750.
• 4. Malik AI, Nelson RL, Tou S. Incision and drainage of perianal abscess with or without treatment of anal fistula. Cochrane Database Syst Rev. 2010;7:CD006827. doi: 10.1002/14651858.CD006827.pub2
• 5. Sigmon DF, Emmanuel B, Tuma F. Perianal Abscess. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2023.
• 6. Perera AP, Howell AM, Sodergren MH, et al. A pilot randomised controlled trial evaluating postoperative packing of the perianal abscess. Langenbecks Arch Surg. 2015;400(2):267-271. doi: 10.1007/s00423-014-1231-5
• 7. Charalampopoulos A, Papakonstantinou D, Bagias G, Nastos K, Perdikaris M, Papagrigoriadis S. Surgery of Simple and Complex Anal Fistulae in Adults: A Review of the Literature for Optimal Surgical Outcomes. Cureus. 2023;15(3):e35888. doi: 10.7759/cureus.35888.
• 8. Whiteford MH. Perianal abscess/fistula disease. Clin Colon Rectal Surg. 2007;20(2):102-109. doi: 10.1055/s-2007-977488.
• 9. Malik AI, Nelson RL. Surgical management of anal fistulae: a systematic review. Colorectal Dis. 2008;10(5):420-430. doi: 10.1111/j.1463-1318.2008.01483.x.
• 10. Ramanujam PS, Prasad ML, Abcarian H, Tan AB. Perianal abscesses and fistulas. A study of 1023 patients. Dis Colon Rectum. 1984;27(9):593-597. doi: 10.1007/BF02553848.
• 11. Cox SW, Senagore AJ, Luchtefeld MA, Mazier WP. Outcome after incision and drainage with fistulotomy for ischiorectal abscess. Am Surg. 1997;63(8):686-689.
• 12. Lohsiriwat V, Yodying H, Lohsiriwat D. Incidence and factors influencing the development of fistula-in-ano after incision and drainage of perianal abscesses. J Med Assoc Thai. 2010;93(1):61-65.
• 13. Arkenbosch JHC, van Ruler O, de Vries AC, van der Woude CJ, Dwarkasing RS. The role of MRI in perianal fistulizing disease: diagnostic imaging and classification systems to monitor disease activity. Abdom Radiol (NY). 2025;50(2):589-597. doi: 10.1007/s00261-024-04455-w.
• 14. de Kalbermatten S, Martin D, Uldry E, et al. Impact of diabetes mellitus on postoperative complications in patients undergoing pancreatic surgery. HPB (Oxford). 2025;27(4):530-537. doi: 10.1016/j.hpb.2024.12.020.
• 15. Bük ÖF, Ocak S, Avcı MA, Akgün C, Bidil MG. Outcomes of Loose Seton Followed by Fistulotomy in Transsphincteric Perianal Fistulas: A Retrospective Study. Turk J Colorectal Dis. 2024;34(2):50-53. doi: 10.4274/tjcd.galenos.2024.2024-3-1.