Katy is a consultant colorectal surgeon from Manchester. During her specialty training she was the lead trainee (deputy CI) for the PPAC2 trial, as part of the North West Surgical Research Collaborative.

Presentation at The Society of Tissue Viability 2025 Conference

The Impact of postoperative packing of perianal abscess cavities: a multicentre RCT – challenging wound care dogma. Results and discussion about de-implementation

Objectives

The presentation is aimed at:

• TVNs, community nurses

Delegates will learn about:

• Packing of perianal (and possibly other anatomical sites) abscess cavities is painful and unnecessary

Abstract

Background – Perianal abscess is common. Traditionally, postoperative perianal abscess cavities are managed with internal wound packing, a practice not supported by evidence. The aim of this randomized clinical trial (RCT) was to assess if non-packing is less painful and if it is associated with adverse outcomes.

Methods – The Postoperative Packing of Perianal Abscess Cavities (PPAC2) trial was a multicentre, RCT (two-group parallel design) of adult participants admitted to an NHS hospital for incision and drainage of a primary perianal abscess. Participants were randomized 1:1 to receive continued postoperative wound packing or non-packing. Blinded data were collected via symptom diaries, telephone, and clinics over 6 months. The objective was to determine whether non-packing of perianal abscess cavities is less painful than packing, without an increase in perianal fistula or abscess recurrence. The primary outcome was pain (mean maximum pain score on a 100-point visual analogue scale).

Results – Between February 2018 and March 2020, 433 participants (mean age 42 years) were randomized across 50 sites. Two hundred and thirteen participants allocated to packing reported higher pain scores than 220 allocated to non-packing (38.2 versus 28.2). The occurrence of fistula-in-ano was low in both groups: 32/213 (15 per cent) in the packing group and 24/220 (11 per cent) in the non-packing group. The proportion of patients with abscess recurrence was also low: 13/223 (6 per cent) in the non-packing group and 7/213 (3 per cent) in the packing group.

Conclusion – Avoiding abscess cavity packing is less painful without a negative morbidity risk.

These data have been published and widely presented but how to effectively de-implement a long established community nursing intervention remains unclear. A de-implentation pilot has been run in manchester, and wil be discussed.