Abstract

Abstract
Background: Perianal fistula is a common complication following surgical drainage of perianal abscesses. This study aimed to determine the incidence and risk factors associated with fistula-in-ano development after perianal abscess drainage.
Methods: A prospective, hospital-based cross-sectional study was conducted at Omdurman Teaching Hospital from January to June 2022. One hundred patients who underwent incisional drainage for perianal abscess were included and followed up for two months. Demographic data, medical history, operative details, and outcomes were recorded. Chi-square test and ANOVA were used for statistical analysis.
Results: The incidence of fistula-in-ano after perianal abscess drainage was 23%. Significant risk factors for fistula development included male gender (28.9% vs 4.2%, p=0.01), longer duration between symptom onset and presentation (12±9 vs 6±5 days, p=0.001), preoperative antibiotic use (57.9% vs 15.8%, p=0.001), and diabetes (63.6% vs 18%, p=0.001). General anesthesia was associated with higher fistula rates compared to spinal anesthesia (31% vs 11.9%, p=0.02). Fistula occurrence decreased with increasing operator experience, from 60% for medical officers to 0% for consultants (p=0.004).
Conclusion: The incidence of fistula-in-ano following perianal abscess drainage was 23%. Male gender, delayed presentation, preoperative antibiotic use, diabetes, general anesthesia, and lower operator experience were identified as significant risk factors. These findings may guide clinical decision-making and patient counseling in the management of perianal abscesses.

Key words: Perianal abscess, fistula-in-ano, risk factors, surgical drainage, anorectal surgery.