Chen SZ, Sun KJ, Gu YF, Zhao HY, Wang D, Shi YF, Shi RJ. Proposal for a new classification of anorectal abscesses based on clinical characteristics and postoperative recurrence. World J Gastrointest Surg 2024; 16(11): 3425-3436 [DOI: 10.4240/wjgs.v16.i11.3425]
Corresponding Author of This Article
Ren-Jie Shi, MD, Chief Doctor, Professor, First Clinical Medical College, The Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Nanjing 210029, Jiangsu Province, China. 949194350@qq.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Shan-Zhong Chen, Ren-Jie Shi, First Clinical Medical College, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
Shan-Zhong Chen, Kui-Jun Sun, Yi-Fan Gu, Hong-Yuan Zhao, Department of Anorectal Surgery, People's Hospital of Yangzhong, Zhenjiang 212200, Jiangsu Province, China
Dong Wang, Department of Ultrasound Medicine, People's Hospital of Yangzhong, Zhenjiang 212200, Jiangsu Province, China
Yun-Fang Shi, Department of Medical Imaging, People's Hospital of Yangzhong, Zhenjiang 212200, Jiangsu Province, China
Ren-Jie Shi, Department of Colorectal Surgery, Jiangsu Province Hospital of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
Author contributions: Chen SZ and Shi RJ designed the research study; Chen SZ and Sun KJ performed the surgeries; Chen SZ, Gu YF and Zhao HY conducted follow-ups, collected the data, and drafted the article; Shi RJ and Sun KJ analyzed the data and made critical revisions to the article; Wang D performed the ultrasound reading; Shi YF performed the magnetic resonance imaging reading; all authors have read and approved the final manuscript.
Supported byThe Zhenjiang City Key Research and Development Plan Social Development, China, No. SH2023047.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Yangzhong People's Hospital, No. KY202317.
Informed consent statement: The requirement for written informed consent was waived due to its retrospective and anonymous nature of this study.
Conflict-of-interest statement: All authors declare no conflicts of interest related to the study.
Data sharing statement: Data from this study can be obtained from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ren-Jie Shi, MD, Chief Doctor, Professor, First Clinical Medical College, The Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Nanjing 210029, Jiangsu Province, China. 949194350@qq.com
Received: June 29, 2024 Revised: September 12, 2024 Accepted: September 23, 2024 Published online: November 27, 2024 Processing time: 122 Days and 23.7 Hours
Abstract
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 χ² 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 χ² 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.
Core Tip: This retrospective study evaluated the predictive factors for postoperative anorectal abscess recurrence and proposed a new classification to guide surgical procedures, including incision and drainage alone or a combined concurrent fistulotomy. We found that the recurrence rate of fistula-prone and non-fistula-prone abscesses (FPAs) was 81.0% and 23.5%, respectively. Additionally, we demonstrated that FPAs, a duration ≥ 7 days from symptom onset to surgery, chronic diarrhea, and local anesthesia were independent risk factors for postoperative anorectal abscess recurrence. Our findings support using this new classification to guide the choice of surgical procedures for treating anorectal abscesses.
