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Session: ePoster: Benign Anorectal 2 (Sun1230)

EP411 - Deep Postanal Space Abscesses: Prolonged Treatment Duration is Required to Achieve Healing

Sunday, May 11, 2025
12:51 PM – 12:56 PM PT
Location: Monitor 2, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • VA

    Vitor Abrantes, MD

    Resident
    Mayo Clinic
    Mayo Clinic College of Medicine and Science
    Rochester, MN, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • KB

    Katherine A. Bews, MS

    Data Scientist
    Mayo Clinic
    Rochester, Minnesota, United States

    Disclosure information not submitted.

  • Kellie L. Mathis, M.D. (she/her/hers)

    Professor of Surgery
    Mayo Clinic
    Mayo Clinic
    Oronoco, Minnesota, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no relevant relationships with ineligible companies.

  • Scott R. Kelley, MD

    Professor of Surgery
    Mayo Clinic
    Rochester, Minnesota, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • NM

    Nicholas P. McKenna, M.D.

    Assistant Professor of Surgery
    Mayo Clinic
    Rochester, Minnesota, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Vitor Barbosa Abrantes, MD: This individual has no financial relationships with ineligible companies.
Kellie L. Mathis, M.D.: This individual has no relevant relationships with ineligible companies.
Nicholas P. McKenna, M.D.: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Deep postanal space abscesses are an often discussed but rarely encountered anorectal pathology. This has resulted in limited data on their treatment and long-term wound healing being available. This study aimed to describe the operative management and long-term outcomes of deep postanal space abscesses.

Methods/Interventions: Adult patients treated for deep postanal space abscesses at a tertiary referral center between 2000 and 2024 were identified. The primary outcome was overall wound healing (defined as an asymptomatic patient with all setons/drains removed or proctectomy). Secondary outcomes included the number of surgical interventions performed and overall treatment duration. Univariate comparisons between patients who had healed versus those who had not healed at last follow-up were performed. A cumulative incidence curve was constructed to assess the proportion of patients achieving complete healing over time. Patients were followed from the date of the initial intervention until either documentation of healing or last follow-up with colon and rectal surgery.

Results/Outcomes: A total of 69 patients (84% male) with a median age of 52 years (interquartile range [IQR]: 40-61) were included. The percent of patients with complete healing rapidly increased the first two years before tapering off - 31% at 1 year, 52% at 2 years, 66% at 5 years (FIGURE). Patients who had not healed at last follow-up had required more operative interventions (median 5, IQR: 3-9) compared to patients with documented healing (median 3, IQR: 2-5; p< 0.05). Nine patients (13%) required temporary diversion, with five undergoing eventual stoma closure. Additionally, three patients required an APR, and one underwent a total proctocolectomy. Age, sex, a diagnosis of inflammatory bowel disease, and diabetes did not differ between patients who healed and those who had not.
Of the 39 patients with an identified perianal fistula who underwent attempted closure, 23 (59%) healed. Treatments included fistulotomy (n=19, 49%), fistula plug (n=9, 23%) anorectal advancement flap (n=9, 23%), laser assisted closure (n=6, 15%), and ligation of the intersphincteric fistula tract (n=3, 8%). Twelve patients (31%) required two or more attempts at definitive fistula closure.

Conclusion/Discussion: Deep postanal space abscesses are associated with prolonged treatment durations and a high likelihood of requiring multiple surgical interventions to achieve healing. Despite these challenges, long-term follow-up shows that healing is achievable even years after the initial abscess drainage. These data will help colorectal surgeons clearly communicate realistic healing expectations and the associated timeframe for patients with deep postanal space abscesses.