Tamponade Dressing versus Regular Dressing Following Incision and Drainage of Perianal Abscess: A Prospective Observational Study

1. 3^rd Year Postgraduate Student, Department of General Surgery, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India. 2. Professor, Department of General Surgery, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India.

Abstract

Introduction: Perianal abscess is a common anorectal emergency typically managed by Incision and Drainage (I&D). However, the optimal postoperative dressing method remains controversial, with limited evidence comparing tamponade dressing and regular dressing regarding wound healing and fistula formation.

Aim: To compare tamponade dressing and regular dressing following I&D of perianal abscess with respect to postoperative pain severity, wound healing, healing duration, postoperative complications, and fistula-in-ano formation.

Materials and Methods: This prospective observational study was conducted in the Department of General Surgery of Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India, from November 2024 to April 2026. A total of 62 adult patients with primary perianal abscesses were included and equally categorised into tamponade dressing (n=31) and regular dressing (n=31) groups. All patients underwent I&D under appropriate anaesthesia. Outcomes assessed included postoperative pain severity, wound healing status, healing duration, postoperative complications, and fistula-in-ano during follow-up. Data were analysed using Statistical Package for Social Sciences (SPSS) version 26.0. Independent samples t-test, Pearson’s Chi-square test, and Fisher’s-exact test were applied as appropriate. A p-value <0.05 was considered statistically significant.

Results: The mean age of participants was 42.60±15.65 years and 36 (58.1%) were males. Baseline demographic and clinical characteristics were comparable between the groups. Mild postoperative pain was observed in 15 (48.4%) patients in the tamponade group and 9 (29.0%) in the regular dressing group, while severe pain occurred in 4 (12.9%) and 8 (25.8%) patients, respectively (p=0.225). Healthy wound healing was noted in 24 (77.4%) patients receiving tamponade dressing compared with 17 (54.8%) receiving regular dressing (p=0.163). Healing within two weeks occurred in 14 (45.2%) and 8 (25.8%) patients, respectively, whereas healing beyond four weeks occurred in 5 (16.1%) and 12 (38.7%) patients. Healing duration showed a significant trend favouring tamponade dressing (p=0.038). The overall postoperative complication rate was significantly lower in the tamponade dressing group than in the regular dressing group (3.2% vs. 29.0%, p=0.006). Fistula-in-ano developed in 3 (9.7%) patients receiving tamponade dressing compared with 8 (25.8%) patients receiving regular dressing (p=0.096).

Conclusion: Tamponade dressing demonstrated a lower numerical incidence of fistula formation; however, the difference was not statistically significant.

Abscess, Fistula-in-ano, Postoperative care, Wound packing

Perianal abscess is among the most frequently encountered anorectal emergencies in general surgical practice. It arises predominantly from cryptoglandular infection resulting in localised pus collection within the perianal or perirectal tissues. The reported incidence ranges from approximately 16-20 cases per 100,000 population annually, with a marked male predominance and peak occurrence between the third and fifth decades of life (1).

Prompt I&D remains the cornerstone of treatment and is recommended as the standard of care by major colorectal surgical guidelines (2). Surgical drainage effectively relieves pain, evacuates purulent collections, controls local sepsis, and prevents extension of infection into deeper anorectal spaces (3). Despite appropriate surgical treatment, the incidence of fistula-in-ano following abscess drainage remains substantial.

Previous studies have reported fistula formation rates ranging from 30% to 50%, making it one of the most significant long-term complications of anorectal sepsis (4). Postoperative wound management remains an area of ongoing debate. Traditionally, surgeons have utilised tamponade dressing or cavity packing after drainage of perianal abscesses. The theoretical advantages of tamponade dressing include maintenance of cavity patency, prevention of premature superficial closure, reduction of dead space, facilitation of continuous drainage, and promotion of healing from the wound base (5),(6).

Growing evidence has challenged the routine use of packing following abscess drainage. Systematic reviews and comparative studies have suggested that non packing strategies may achieve similar rates of wound healing and recurrence while reducing patient discomfort (7),(8). Consequently, considerable variation exists among surgeons regarding postoperative wound care practices.
Given these conflicting findings and the limited availability of prospective comparative data from Indian tertiary care settings, the present study was undertaken to compare tamponade dressing and regular dressing following I&D of perianal abscess.

Material and Methods

This prospective observational study was conducted in the Department of General Surgery at Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India, from November 2024 to April 2026. The study was conducted after obtaining approval from the Institutional Human Ethics Committee of Sree Balaji Medical College (Ref no: 002/SBMCH/IHEC/2024/2317 dated 05.10.2024).

Sample size: A total of 62 patients who met the eligibility criteria were enrolled consecutively using a consecutive sampling technique during the study period and categorised into either the tamponade dressing group or the regular dressing group, based on the postoperative dressing technique used in routine clinical practice. The choice of dressing technique was made by the treating surgeon, and no investigator-directed allocation or randomisation was performed.

Inclusion criteria:

•Patients aged 18 years and above;
•Patients with primary perianal abscess requiring surgical I&D;
•Patients willing to provide written informed consent.

Exclusion criteria:

•Recurrent perianal abscess;
•Pre-existing fistula-in-ano;
•Crohn’s disease;
•Tuberculosis involving the anorectal region;
•Anorectal malignancy;
•Immunocompromised states, including patients receiving immunosuppressive therapy;
•Patients unwilling to participate in the study.

Study Procedure

All patients underwent I&D of the perianal abscess under spinal or general anaesthesia according to clinical indication and surgeon preference. Following adequate drainage of pus, loculations were broken down, and the abscess cavity was thoroughly explored. Postoperatively, patients were managed using one of two dressing techniques:

Group A (Tamponade dressing): The abscess cavity was packed with sterile gauze immediately after drainage. Packing was gradually reduced during subsequent dressing changes until complete healing was achieved.

Group B (Regular dressing): The abscess cavity was left unpacked and covered with a sterile external dressing without cavity packing.
Both groups received standard postoperative care, including analgesics, sitz baths, hygiene advice, and antibiotics when clinically indicated, as determined by the treating surgeon based on the patient’s clinical presentation. Routine pus culture and antibiotic susceptibility testing were not performed for all patients. Patients were followed regularly in the outpatient department for a period of three months to assess complete wound healing, postoperative complications, and the development of fistula-in-ano.

Outcome measures: Baseline demographic and clinical variables recorded included age, gender, presenting symptoms (pain, swelling, fever, discharge, difficulty in sitting, and constipation), and abscess location.

The primary postoperative outcome measures were: Pain severity was assessed using the Visual Analogue Scale (VAS) and categorised as mild (1-3), moderate (4-6), or severe (7-10) (9). Wound healing was assessed clinically based on the extent of healthy granulation tissue, presence of slough or purulent discharge, and time to healing. Healing was classified as healthy (≥75% healthy granulation tissue with no evidence of infection), delayed (25-74% healthy granulation tissue or delayed epithelialisation beyond two weeks without active infection), or unhealthy (<25% healthy granulation tissue and/or persistent slough, purulent discharge, or wound infection), based on standard wound assessment principles (10). Healing duration was categorised as ≤2 weeks, 3-4 weeks, and >4 weeks. Postoperative complications were recorded as present or absent. Development of fistula-in-ano was assessed clinically during follow-up visits.

STATISTICAL ANALYSIS

Data were analysed using SPSS software version 26.0 (IBM Corp., Armonk, NY, USA). Continuous variables were expressed as Mean±Standard Deviation (SD), whereas categorical variables were presented as frequencies and percentages. The mean age of the two groups was compared using the Independent samples t-test. Associations between dressing type and categorical variables were analysed using Pearson’s Chi-square test. Fisher’s-exact test was applied whenever expected cell counts were less than five. A p-value <0.05 was considered statistically significant.

Results

The overall mean age of the study population was 42.60±15.65 years, with an age range of 18 to 65 years (Table/Fig 1).

Among all patients, 24 (38.7%) experienced mild pain, 26 (41.9%) experienced moderate pain, and 12 (19.4%) experienced severe pain. In the tamponade dressing group, mild pain was observed in 15 patients (48.4%), moderate pain in 12 patients (38.7%), and severe pain in four patients (12.9%) (Table/Fig 2).

Fistula-in-ano was observed in three patients in the tamponade dressing group (9.7%) and eight patients in the regular dressing group (25.8%). In the present study, 10 patients (16.1%) developed complications (postoperative bleeding and wound soakage), and 52 patients (83.9%) did not experience any complications (Table/Fig 3).

Postoperative complications monitored in the current study were wound soakage, secondary infection, postoperative bleeding, and urinary retention. In the present study, one patient (3.2%) developed postoperative bleeding in the Tamponade group, and nine patients had wound soakage in the regular group (29%).

Discussion

The mean age of the study population was 42.60±15.65 years, and males constituted 58.1% of patients. Tonkin DM et al., in their pilot comparative study, also reported that perianal abscess predominantly affected middle-aged adults and was male-predominant, with most patients presenting during the fourth and fifth decades of life (11).

In the present study, tamponade dressing showed a more favourable pain distribution despite the absence of statistical significance. Perera AP et al., in the Postoperative Packing of Perianal Abscess Cavities (PPAC) pilot randomised controlled trial, reported lower postoperative pain scores among patients managed without packing, particularly during the first postoperative week, although healing outcomes remained comparable between groups (12). Similarly, Newton K et al., in the PPAC2 multicentre randomised trial involving 433 patients, reported significantly lower mean pain scores in the non packing group, with approximately 38% lower pain scores compared with packed wounds (13). Crook DL and Padfield O, evaluating long-term outcomes of the PPAC2 cohort, further demonstrated that non packing reduced patient discomfort without increasing recurrence or fistula formation (8).

In contrast, Langenbach MR et al., conducted a multicentre randomised clinical trial comparing tamponade dressing with no dressing following haemorrhoidectomy and reported that omission of tamponade dressing was associated with significantly lower postoperative pain without compromising surgical outcomes (14). These findings further support the growing evidence that routine wound packing or tamponade may not provide additional clinical benefit in anorectal procedures and may adversely affect patient comfort. However, haemorrhoidectomy wounds differ substantially from post-I&D abscess cavities with respect to wound characteristics, healing mechanisms, and the risk of premature cavity closure. Therefore, direct comparison with the present study should be interpreted with caution.

Unlike these studies, the current study results demonstrated numerically lower severe pain rates in the tamponade dressing group. This discrepancy may be attributable to differences in packing technique, with gradual reduction of the packing material during successive dressing changes rather than repeated tight cavity packing. In addition, variations in abscess size, cavity depth, disease severity, postoperative analgesic protocols, and the single-centre tertiary care setting may have influenced pain perception and postoperative recovery.

Current clinical practice guidelines by Vogel JD et al., acknowledge that postoperative outcomes after anorectal abscess drainage remain variable because of differences in wound-care practices and limited high-quality comparative evidence (15).

Limitation(s)

First, the study was conducted at a single tertiary care centre, which may limit the generalisability of the results to other healthcare settings and populations. Second, the sample size was relatively small (N=62), reducing the statistical power to detect significant differences in some clinically important outcomes, particularly fistula-in-ano formation and wound healing status. Third, allocation to dressing groups was based on routine clinical practice rather than randomisation, which may have introduced selection bias despite comparable baseline characteristics between groups. Fourth, the duration of follow-up was limited and may not have captured all cases of delayed recurrence or late fistula development. Fifth, pain assessment was categorised into severity groups rather than evaluated using serial quantitative VAS scores over time, which may have reduced sensitivity in detecting differences between dressing methods. Finally, potential confounding factors such as abscess size, cavity depth, smoking status, nutritional status, and associated comorbidities were not analysed separately and may have influenced postoperative healing outcomes.

Conclusion

Tamponade dressing was associated with significantly shorter healing duration and fewer postoperative complications. Although differences in pain severity, wound healing status, and fistula-in-ano formation did not reach statistical significance, the overall clinical pattern consistently favoured tamponade dressing.

DOI and Others

DOI: 10.7860/JCDR/2026/90935.24337

Date of Submission: Jun 02, 2026
Date of Peer Review: Jun 26, 2026
Date of Acceptance: Jul 19, 2026
Date of Publishing: Sep 01, 2026

AUTHOR DECLARATION:

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

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ETYMOLOGY: Author Origin

EMENDATIONS: 7