From the Guidelines
The purpose of packing material after incision and drainage of an anorectal abscess is not clearly established.
Key Points
- The use of packing after drainage of an anorectal abscess remains unproven 1.
- Common practice is to place an internal dressing (pack) into the cavity following incision and drainage, both for hemostasis and to prevent the premature closure of the skin 1.
- The pack is then changed regularly until the cavity heals, but this practice may cause pain and additional healthcare expense 1.
- A recent Cochrane review found that it is unclear whether using internal dressings (packing) for the healing of perianal abscess cavities influences time to healing, wound pain, development of fistulae, abscess recurrence, or other outcomes 1.
- A subsequent multi-center observational study found that packing is costly and painful and does not add benefit to the healing process 1.
Recommendations
- No recommendation can be made regarding the use of packing after drainage of an anorectal abscess, based on the available literature 1.
- The use of packing should be left to individual unit policy and patient discussion 1.
From the Research
Purpose of Packing Material
The purpose of packing material after incision and drainage is a topic of debate, with various studies investigating its effectiveness.
- The use of packing material is thought to aid hemostasis and prevent reorganization of the abscess 2.
- However, several studies have found that packing does not significantly impact the failure or recurrence rates after incision and drainage 3, 4, 2, 5.
- In fact, some studies have found that omitting packing can be less painful for patients without increasing the risk of adverse outcomes 4, 2, 6.
Findings from Studies
- A study published in 2017 found that packing does not affect outcomes for abscesses less than 5 cm in non-diabetic, non-immunocompromised individuals 3.
- A randomized clinical trial published in 2022 found that non-packing is less painful than packing without an increase in perianal fistula or abscess recurrence 4.
- A study published in 2013 found that incision and drainage of subcutaneous abscesses without the use of packing is a safe and effective technique 2.
- A review published in 2023 concluded that routine postoperative packing of perianal abscesses following incision and drainage is costly, associated with increased pain, and confers no protection against recurrence of abscesses or formation of fistulae 6.
- A randomized trial published in 2012 found that wound packing does not appear to significantly impact the failure or recurrence rates after simple incision and drainage 5.