Publication

Abstract : Introduction: Fistula in ano, once called “The Royal Disease” has been described from the time of Hippocrates. The earliest successful treatment described in literature is for King Louis XIV. This common ano-rectal disorder still continues to cause significant discomfort for patients. The traditional management of perianal abscess is a cruciate incision & drainage, resulting in morbidity. The wound takes months to heal with chronic pain, scarring and discomfort. Literature reports fistula formation in 35-50% following treatment of perianal abscess. Methodology: This is a case series of 5 patients (3males & 2females) who presented with perianal abscess. MRI done showed intersphincteric tract in 3 patients, horse shoe abscess in one and trans-sphincteric collection in one patient. Under anesthesia, a 3mm incision was placed at the region of maximum induration. Methylene blue+ hydrogen peroxide was injected into the cavity and internal opening was visualized. A 3mm fistuloscope was inserted into the cavity through the incision and the entire cavity was visualized upto the internal opening. All slough and unhealthy tissue was removed and the walls of the cavity fulgurated(Video). The internal opening was then closed using 2-0 vicryl in a “figure of 8” pattern. Horizontal centrifugation-Platelet rich fibrin (H-PRF) was placed into the treated cavity. Patients were discharged next day and followed up for 3 months postoperatively. All patients reported minimal pain for 2-3 days and complete cessation of discharge by 2nd week without progression to fistula. Discussion: Conventional treatment of acute perianal abscess is a large cruciate incision at the region of maximum fluctuation and breaking the septa within the abscess cavity. This may cause damage of the sensory nerves supplying the perianal region. Use of minimally invasive methods prevents this disruption in the anatomy of the region reducing morbidity and hastens healing. Escherichia Coli and skin commensals like Staphylococcus aureus are the most common isolates from a perianal abscess. H-PRF has tissue factors that can accelerate wound healing and also has an antimicrobial effect against E.Coli and staphylococcus. Conclusion: Minimally Invasive Treatment of AnoRectal Abscess with H-PRF instillation helps in efficient, early, cosmetic and cost-effective healing of this painful condition. A large section of the population in low resource or rural settings can be benefitted by this procedure with minimal modification to the operative technique.