Perianal abscess (PA) commonly present with collections requiring surgical intervention. The most common cause of a PA formation is secondary to anal gland sepsis. The most common clinical features are perianal pain and swelling if the anorectal area is the portal of entry, whereas urinary retention, testicular, or scrotal pain are present if the infection launches from the genitourinary tract.1 Other systemic manifestations such as fever, tachycardia, electrolyte imbalances, and hyperglycemia may also be present. Large abscesses and anaerobic bacteria are associated with worse outcome. Hemodynamic support and parenteral broad-spectrum antibiotics are required to control severe sepsis, but prompt surgical debridement of all devitalized tissue is the mainstay of treatment. Abscess management is fairly complicated. It requires striking a balance between rates of healing and potential alteration of fecal continence. Tissues that can easily be divided from the anal sphincter by digital dissection must completely be removed. Therefore, wide debridement is required, which leaves large defects to be covered. Reconstruction is challenging due to humidity, contamination and irregularity of the perianal area. Appropriate selection of patients and choice of repair technique should yield higher success rates with lower associated morbidity. The ultimate reduction in postoperative hospital costs to make the traditional open incision and drainage (I&D) most cost-effective would be to perform the procedure with minimally invasive surgery.
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