title: The initial approach to anorectal abscesses: fistulotomy is safe and reduces the chance of recurrences.
abstract: OBJECTIVE
  Anorectal abscesses are most frequently based on a coexistent fistula in ano. Whether these should be searched for and excised initially or not remains controversial. Our aim was to determine which approach has less recurrences and carries a lower risk of continence disorders.
  
  
  METHODS
  158 patients with an anorectal abscess or anal fistula were identified in our institution over a period of 75 consecutive months. The records and follow-up questionnaires of 131 patients were evaluable. The mean follow-up period was 40 (range 3-78) months.
  
  
  RESULTS
  When fistulotomy was performed at the time of draining the abscess, the recurrence rate could be reduced, in comparison to incision and drainage alone, from 34 to 4% (p = 0.007). In the group of patients undergoing surgery for a recurrence, the recurrence rate could even be reduced from 67 to 0% (p = 0.03) by simultaneous fistulotomy. A total of 4 of the 131 patients (3%) developed incontinence of liquid stool and flatus, but no incontinence of solid stool occurred. Incontinence did only occur after recurrent disease.
  
  
  CONCLUSIONS
  The number of recurrences requiring surgery can be significantly reduced by initial fistulotomy. The risk to develop incontinence increases with recurrent anorectal disease, not with careful fistulotomy.
authors.affiliation: Department of Surgery, University of Hamburg, Germany. knoefel@uke.uni-hamburg.de
authors.forename: W T
authors.initials: WT
authors.lastname: Knoefel
authors.forename: S B
authors.initials: SB
authors.lastname: Hosch
authors.forename: B
authors.initials: B
authors.lastname: Hoyer
authors.forename: J R
authors.initials: JR
authors.lastname: Izbicki
mesh_terms: D000038:Abscess / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012002:Rectal Diseases / Q000601:surgery*; D012003:Rectal Fistula / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation