The management of anorectal abscess: An inexpensive and simple alternative technique to incision and "deroofing".

All patients with anorectal abscess who were referred to the University Department of Surgery in Wellington have been managed by simple "de Pezzer" drainage since 1981. The catheter used was between 3 to 5 mm in diameted and was usually inserted under a local anesthetic. The method is described in detail. One hundred and fifty-seven patients have presented with anorectal abscess, and after exclusion of those patients with intersphincteric abscess, 140 have been managed using de Pezzer drainage. The male to female ratio was 2.7:1. A perianal abscess was present in 120 patients. General anesthesia was necessary in 23 patients, and 20 of these patients were admitted to the hospital. Thirteen patients were admitted for underlying medical problems. Three patients had Crohn's disease and five were diabetics. Seventy-four of the patients had symptoms that had lasted for 4 days or less, and 40 patients had antibiotics prescribed by their local practitioners. There was no past history of anorectal sepsis in 104 patients. Ninety-four of the catheters were removed in less than 15 days. Of the patients who were drained under local anesthetic only, eight said that the pain was so "intolerable" that they would opt for a general anesthesia in the future. Fifty-three patients returned to their normal activities or work within five days, and 107 were back at work 14 days after drainage. Three abscesses were inadequately drained. Fistulae developed in 37 patients within the follow-up period. The technique appears to be safe and reliable, is well tolerated by patients, and results in minimal hospitalization and an early return to work.