Postoperative Packing of Perianal Abscess Cavities (PPAC2): randomized clinical trial

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For many years there has been debate over the merit of packing vs leaving open of perianal abscess cavities following surgical incision and drainage. Surgical dogma is that packing reduces the rate of perianal fistula formation and abscess recurrence, although there was no clinical evidence to support this. This paper informs the evidence on whether or not we should pack perianal abscess cavities.

Methods:

433 participants (mean age 42 years) were randomized across 50 sites to receive continued wound packing or non-packing following surgical incision and drainage of perianal abscess.

Key findings:

Pain: participants allocated to packing reported higher pain scores than those allocated to non-packing (38.2 versus 28.2, mean difference 9.9; P< 0.0001).

Fistula-in-ano occurrence: was low in both groups: 32/213 (15%) in the packing group and 24/220 (11%) in the non-packing group (OR 0.69, 95%CI 0.39 to 1.22; P=0.20).

Wound healing: Over the 6-month follow-up period, a total of 112/163 (69%) in the packing group and 138/175 (79%) in the no-packing group were observed as healed (P=0.046).

Recurrence: 13/223 (6%) in the non-packing group and 7/213 (3%) in the packing group (OR 1.85, 95%CI 0.72 to 4.73; P=0.20)

Health Related Quality of Life: no significant differences between the treatment groups.

Returning to work: 65% of the packing group versus 80% of the non-packing group had returned to work 21 days after their incision and drainage operation

Authors’ conclusions:

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