title: How the anal gland orifice could be found in anal abscess operations.
abstract: BACKGROUND
  On an average 30-50% of patients who undergo incision and drainage (I and D) of anal abscess will develop recurrence or fistula formation. It is claimed that finding the internal orifice of anal abscess to distract the corresponding anal gland duct; will decline the rate of future anal fistula. Surgeons supporting I and D alone claim that finding the internal opening is hazardous. This study is conducted to assess short-term results of optional method to manage patients with anal abscess and fitula-in-ano at the same time.
  
  
  METHODS
  In this cross-sectional descriptive study 49 from 77 patients with anal abscess whose internal orifice was not identified by pressing on the abscess, diluted hydrogen peroxide (2%) and methylene blue was injected into the abscess cavity and the anal canal was inspected to find out the internal opening. Once the opening was distinguished, an incision was given from the anal verge to the internal opening.
  
  
  RESULTS
  The internal orifice was identified in 44 out of 49 patients (90%) who underwent this new technique. Up to 18 months during follow-up, only 2.5% of patients with primary fistulotomy developed fistula on the site of a previous abscess.
  
  
  CONCLUSIONS
  Conventional method to seek the internal orifice of anal abscesses is successful in about one-third of cases. By applying this new technique, surgeons would properly find the internal opening in >90% of patients. Needless to say, safe identification of the anal gland orifice in anal abscess disease best helps surgeons to do primary fistulotomy and in turn it would significantly decrease the rate of recurrence in anal abscess and fistula formation.
authors.affiliation: Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Shahram
authors.initials: S
authors.lastname: Paydar
authors.affiliation: Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Izadpanah
authors.affiliation: Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Leila
authors.initials: L
authors.lastname: Ghahramani
authors.affiliation: Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Seyed Vahid
authors.initials: SV
authors.lastname: Hosseini
authors.affiliation: Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Alimohammad
authors.initials: A
authors.lastname: Bananzadeh
authors.affiliation: Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Salar
authors.initials: S
authors.lastname: Rahimikazerooni
authors.affiliation: Department of Surgery, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Faranak
authors.initials: F
authors.lastname: Bahrami
keywords: Abscess; anal fistula; anal gland; colorectal surgery; drainage