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

作　　者：Shan-Zhong Chen Kui-Jun Sun Yi-Fan Gu Hong-Yuan Zhao Dong Wang Yun-Fang Shi Ren-Jie Shi 

机构地区：[1]First Clinical Medical College,The Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,Jiangsu Province,China [2]Department of Anorectal Surgery,People's Hospital of Yangzhong,Zhenjiang 212200,Jiangsu Province,China [3]Department of Ultrasound Medicine,People's Hospital of Yangzhong,Zhenjiang 212200,Jiangsu Province,China [4]Department of Medical Imaging,People's Hospital of Yangzhong,Zhenjiang 212200,Jiangsu Province,China [5]Department of Colorectal Surgery,Jiangsu Province Hospital of Chinese Medicine,Nanjing 210029,Jiangsu Province,China

出　　处：《World Journal of Gastrointestinal Surgery》2024年第11期3425-3436,共12页世界胃肠外科杂志（英文）

基　　金：Supported by The Zhenjiang City Key Research and Development Plan Social Development,China,No.SH2023047.

摘　　要：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 theχ^(2)test and subsequently analyzed with multivariate logistic regression to evaluate their relationship with postoperative recurrence of anorectal abscesses.RESULTSOne year post-follow-up,the overall recurrence rate was 39%:81.0%and 23.5%for fistula-prone and non-fistulaproneabscesses,respectively.Univariateχ^(2)analysis showed significant differences in recurrence rates based onanatomical classifications and pus culture results(P<0.05).Fistula-prone abscess,≥7 days between symptomonset 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 multivariatelogistic regression.Body mass index≥28(OR=2.935,95%CI:1.203–7.165,P=0.018)was an independentrisk factor for postoperative recurrence of non-fistula-prone abscess.CONCLUSIONThe choice of

关 键 词：Anorectal abscess New classification Clinical characteristics Risk factors Postoperative recurrence rate Surgical procedure 

分 类 号：R657.1[医药卫生—外科学]