The impact of specialist experience in the surgical management of perianal abscesses.

UNLABELLED: Perianal abscesses are one of the most common general surgical emergencies and the management of this can be variable. The aim of our study was to assess the management strategy used by different grades of surgeons in the surgical management of an acute perianal abscess.

MATERIAL AND METHODS: A retrospective analysis was carried out of all patients presenting with an abscess in the perianal region over a two-year period from January 2006 to December 2007. Patient demographics and co-morbidities were noted. The management strategies of different grades of operating surgeon were analysed.

RESULTS: During the two-year period, 147 patients presented with a perianal abscess of whom 52 (28%) had recurrent abscess. Fistulae were identified in 30 patients, with more than half picked up by consultants (P = 0.00001). Consultants performed fistulotomy and Seton insertion in 50% and 17% of patients respectively, whilst registrars performed these procedures in only 4% and 8% of patients (p < 0.00001).

CONCLUSION: Whilst surgical management of the perianal abscess is one of the most common surgical emergency procedures performed by the surgical trainees, input from a senior clinician improves the identification and definitive management of an underlying fistula. This study reinforces the importance of involvement of senior surgeons in the management of this common condition.