Postoperative packing of perianal abscess cavities linked to poor outcomes

UK: According to  PPAC2 trial, which has been published in the British Journal of Surgery, postoperative perianal abscess wound cavities treated without internal wound packing produce noticeably less discomfort without markedly raising the risk of perianal fistula and abscess recurrence.

An infection and swelling around the anus brought on by blockage of the anal glands causes perianal abscess, a frequent and unpleasant illness. For more than 50 years, there has been no change in how perianal abscess is treated. Following surgical abscess incision and drainage while under general anesthesia, the community will continue to dress (pack) the resulting wound cavity internally until the wound is healed. There is no evidence to support the surgical orthodoxy that packing decreases the rate of perianal fistula development and abscess recurrence.

The Postoperative Packing of Perianal Abscess Cavities (PPAC2) trial's goal was to ascertain whether leaving perianal abscess cavities unpacked would be less unpleasant overall while reducing the risk of perianal fistula and abscess recurrence.

This research was accomplished with the help of the Postoperative Packing of Perianal Abscess Cavities (PPAC2) trial. A primary perianal abscess in an adult participant who had been hospitalized to an NHS hospital for incision and drainage was the subject of a multicenter, RCT (two-group parallel design). Online randomization was used to assign participants in a 1:1 ratio to either continue postoperative wound packing or not. 433 individuals (mean age 42 years) were randomly distributed across 50 sites between February 2018 and March 2020. Over the course of six months, blinded data were gathered through clinics, the phone, and symptom diaries. Pain was the main result (mean maximum pain score on a 100-point visual analogue scale). Secondary endpoints were pain prior to, during, and following dressing changes; postoperative recurrence of perianal fistula and abscess; bleeding (requiring transfusion or return to theatre); and rate of wound healing (at 4, 8, and 26 weeks).