From the Guidelines

The management of a perianal abscess involves surgical drainage with incision and drainage.

The primary treatment of anorectal abscesses remains surgical drainage, with the timing being dictated by the severity and nature of any sepsis 1.
In patients with anorectal abscess, incision and drainage is recommended, with the goal of providing adequate drainage while minimizing the risk of sphincter damage and potential fistula formation 1.
The timing of surgery should be based on the presence and severity of sepsis, with emergent drainage indicated in cases of sepsis, severe sepsis, or septic shock 1.
Outpatient management may be considered for fit, immunocompetent patients with small perianal abscesses and no systemic signs of sepsis 1.
Antibiotic therapy may be considered in patients with drained anorectal abscess and signs of sepsis, surrounding soft tissue infection, or disturbances of the immune response 1.

If an obvious fistula is found at the time of anorectal abscess drainage, it may be laid open if deemed to be subcutaneous by an experienced surgeon, but this should be approached with caution to avoid iatrogenic complications 1.
A loose draining seton may be placed if there is suspicion of sphincteric muscle involvement, and subsequent management options should be discussed with the patient to avoid the risk of incontinence 1.

No recommendation can be made regarding the use of packing after drainage of an anorectal abscess, as the available literature is limited and inconclusive 1.
The use of internal dressings (packing) may be left to individual unit policy and patient discussion, as its benefits and drawbacks are not well established 1.

From the Research

The management of perianal abscesses can be approached through different methods, including surgical and non-surgical interventions.

Non-surgical management has been proposed as a potential treatment option, with benefits including reduced hospital admissions and surgical procedures 2, 3, 4.
Studies have shown that non-surgical intervention can be effective in managing perianal abscesses, especially in pediatric patients, with similar recurrence and fistula formation rates compared to surgical management 2, 3, 4.
Conservative treatment, including antibiotics and regular baths, can be a safe and effective technique for most first-time perianal abscesses, with less recurrence and a lower fistula formation rate 4, 5.

Surgical intervention, such as incision and drainage, may be necessary in some cases, especially when an abscess is likely to spread or shows no sign of spontaneous perforation 4.
However, surgical intervention can be associated with a higher risk of recurrence and fistula formation, especially in cases where the abscess is complex or associated with underlying conditions such as Crohn's disease 6.

Treatment outcomes for perianal abscesses can vary depending on the management approach, with non-surgical intervention resulting in fewer hospital admissions and surgical procedures 2, 3, 4.
Studies have reported varying rates of recurrence and fistula formation, ranging from 10.9% to 24.6%, depending on the treatment approach and patient population 3, 4, 5.
Overall, the management of perianal abscesses requires a careful assessment of the individual patient's condition and a tailored approach to treatment, taking into account the potential benefits and risks of different management options 2, 3, 4, 5, 6.