Compared to standard treatment of packing, no packing of perianal abscess wound cavities results in less pain, without increasing the risk of unwanted abscess recurrence and perianal fistula, according to the findings of a randomized clinical trial (The Postoperative Packing of Perianal Abscess Cavities [PPAC2]).  Katy Newton et al. sought to determine if packing is more painful and whether it is more likely to cause complications such as abscess or perianal fistula recurrence when compared to non-packing.

A total of 433 adult patients (mean age 42 years) who were hospitalized for drainage and incision of a primary perianal abscess were randomly assigned to continue wound packing or no-packing. Over 6-months, blinded data were gathered through clinic visits, phone calls, and symptom diaries. Pain (mean maximum visual analogue scale [VAS] pain score) was the major endpoint ascertained.

More pain was experienced by 213 individuals who were assigned to packing than by 220 participants who were assigned to non-packing (38.2 vs. 28.2, mean difference 9.9), as shown in Figure 1:

Both groups had modest rates of fistula-in-ano: 32/213 (15%) in the packing group and 24/220 (11%) in the non-packing group (Odds Ratio [OR] 0.69).  The percentage of subjects experiencing abscess recurrence was low, with 7/213 (3%) in the packing arm (OR = 1.90) and 13/223 (6%) in the non-packing arm (OR 1.85). To sum up, the promising course of action was to avoid packing perianal abscesses wounds after drainage surgery.