Proposal for a new classification of anorectal abscesses based on clinical characteristics and postoperative recurrence.

Autor:	Chen SZ; First Clinical Medical College, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China.; Department of Anorectal Surgery, People's Hospital of Yangzhong, Zhenjiang 212200, Jiangsu Province, China., Sun KJ; Department of Anorectal Surgery, People's Hospital of Yangzhong, Zhenjiang 212200, Jiangsu Province, China., Gu YF; Department of Anorectal Surgery, People's Hospital of Yangzhong, Zhenjiang 212200, Jiangsu Province, China., Zhao HY; Department of Anorectal Surgery, People's Hospital of Yangzhong, Zhenjiang 212200, Jiangsu Province, China., Wang D; Department of Ultrasound Medicine, People's Hospital of Yangzhong, Zhenjiang 212200, Jiangsu Province, China., Shi YF; Department of Medical Imaging, People's Hospital of Yangzhong, Zhenjiang 212200, Jiangsu Province, China., Shi RJ; First Clinical Medical College, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China.; Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Nanjing 210029, Jiangsu Province, China. 949194350@qq.com.
Jazyk:	angličtina
Zdroj:	World journal of gastrointestinal surgery [World J Gastrointest Surg] 2024 Nov 27; Vol. 16 (11), pp. 3425-3436.
DOI:	10.4240/wjgs.v16.i11.3425
Abstrakt:	Background: Current surgical procedures for anorectal abscesses, including incision and drainage alone or combined concurrent fistulotomy, remain controversial primarily due to the unpredictability of postoperative recurrence or the progression to anal fistula. Aim: To evaluate factors that predict postoperative recurrence of anorectal abscesses and propose a new classification to guide surgical procedures. Methods: In this retrospective study, 525 patients with anorectal abscesses treated by incision and drainage alone, at a tertiary general hospital from August 2012 to July 2022, were included. A new classification for anorectal abscesses based on their propensity to develop into fistulas, considering 18 other potential risk factors, was established. These factors, from electronic medical records, were screened for significance using the χ ² test and subsequently analyzed with multivariate logistic regression to evaluate their relationship with postoperative recurrence of anorectal abscesses. Results: One year post-follow-up, the overall recurrence rate was 39%:81.0% and 23.5% for fistula-prone and non-fistula-prone abscesses, respectively. Univariate χ ² analysis showed significant differences in recurrence rates based on anatomical classifications and pus culture results ( P < 0.05). Fistula-prone abscess, ≥ 7 days between symptom onset and surgery, chronic diarrhea, preoperative antibiotic use, and local anesthesia were risk factors for recurrence, while diabetes mellitus was protective ( P < 0.05). Moreover, fistula-prone abscess [odds ratio (OR) = 7.651, 95%CI: 4.049-14.458, P < 0.001], ≥ 7 days from symptom onset to surgery (OR = 2.137, 95%CI: 1.090-4.190, P = 0.027), chronic diarrhea (OR = 2.508, 95%CI: 1.216-5.173, P = 0.013), and local anesthesia (OR = 2.308, 95%CI: 1.313-4.059, P = 0.004) were independent risk factors for postoperative anorectal abscess recurrence using multivariate logistic regression. Body mass index ≥ 28 (OR = 2.935, 95%CI: 1.203-7.165, P = 0.018) was an independent risk factor for postoperative recurrence of non-fistula-prone abscess. Conclusion: The choice of surgical procedure for treating anorectal abscesses should follow this new classification. Prompt and thorough incision and drainage can significantly reduce postoperative recurrence. Competing Interests: Conflict-of-interest statement: All authors declare no conflicts of interest related to the study. (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)
Databáze:	MEDLINE
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