Post-Operative Packing of Perianal Abscess Drainage: Has the Postoperative Packing of Perianal Abscess Cavities (PPAC2) Trial Changed Our Practice?.
Ehsan, Z Lloyd, A Ali, A Helmy, O Fedder, A Sarma, D
Ehsan, Z
Lloyd, A
Ali, A
Helmy, O
Fedder, A
Sarma, D
Affiliation
SWBH; The Dudley Group NHS Foundation Trust
Other Contributors
Publication date
2025/06/01
Subject
Collections
Research Projects
Organizational Units
Journal Issue
Abstract
Aim: The recent PPAC2 trial found that avoiding cavity packing reduced post-operative pain without increasing morbidity. To evaluate adherence to evidence-based practices for perianal abscess treatment a retrospective audit was conducted from January - July 2024. The new protocol was delivered, and a re-audit was completed from October - December 2024. Method(s): All cases of emergency perianal abscess treatment were analysed at Sandwell Hospital. Results were shared with General Surgery consultants and registrars. A questionnaire was used to gauge if this evidence influenced changes in clinical practice. Exclusion criteria included Crohn's perianal abscesses and recurrent abscesses. Result(s): The first cycle included 45 patients (mean age 39, Male: Female ratio 2.54:1). 89% received post-operative packing. Both packed and unpacked had similar rates of abscess recurrence, fistula formation or readmission with perianal pain within 3 months (20% for packed and 22% for unpacked, OR 1.0). 67% of consultants and registrars reported that this evidence has prompted a change in their clinical management of perianal abscesses. The second cycle included 19 patients (mean age 49, Male: Female ratio: 0.8:1). Only 37% received post-operative packing. No patients included in the re-audit have yet had a re-admission for the above complications. Conclusion(s): The first cycle showed that the trust was not following evidence-based practice. The re-audit showed an encouraging improvement since there was a significant shift in attitude towards adopting this approach of avoiding post-operative packing. Although no patients were re-admitted for the above complications, further analysis is needed to determine the results in the long term.
Citation
Z Ehsan, A Lloyd, A Ali, O Helmy, A Fedder, D Sarma, 542 Post-Operative Packing of Perianal Abscess Drainage: Has the Postoperative Packing of Perianal Abscess Cavities (PPAC2) Trial Changed Our Practice?, BJS, Volume 112, Issue Supplement_10, June 2025, znaf128.549, https://doi.org/10.1093/bjs/znaf128.549