What surgical treatments are available for perianal abscess?

Perianal abscesses are classified into non-fistulous and fistulous types. The former arises from cutaneous infection and can be cured by incision and drainage alone, without fistula formation. The latter originates from infection of the anal sinuses, which spreads to the various perianorectal spaces; incision and drainage alone—without addressing the infected internal opening of the anal sinus—inevitably leads to fistula formation.

Historically, both types have been managed with staged surgical procedures: initial incision and drainage followed later by definitive fistula surgery. This approach often results in persistent purulent or serous discharge, recurrent episodes, prolonged treatment duration, and patient suffering from a second surgical intervention. In fact, once fluctuation is clinically evident, it constitutes an absolute surgical indication—regardless of abscess type—and definitive one-stage radical surgery should be performed: low-level incision combined with high-level seton placement, rather than staged procedures.

Postoperative management: For inpatient surgery, standard postoperative care applies. After surgery, patients undergo fumigation and washing with a compound Jie’jie (Schizonepeta) solution, followed by insertion of “Gangtai” suppositories rectally and external application of sanitary pads. Regular digital anal dilation and dressing changes are performed until complete wound healing is achieved.