Newton, Katy, Dumville, Jo, Briggs, Michelle 
ORCID: 0000-0001-6741-357X, Law, Jennifer, Martin, Julia, Pearce, Lyndsay, Kirwan, Cliona, Pinkney, Thomas, Needham, Alexander, Jackson, Richard et al (show 3 more authors)
(2022)
Postoperative Packing of Perianal Abscess Cavities PPAC2 randomized clinical trial.
BRITISH JOURNAL OF SURGERY, 109 (10).
pp. 951-957.
Abstract
<h4>Background</h4>Perianal abscess is common. Traditionally, postoperative perianal abscess cavities are managed with internal wound packing, a practice not supported by evidence. The aim of this randomized clinical trial (RCT) was to assess if non-packing is less painful and if it is associated with adverse outcomes.<h4>Methods</h4>The Postoperative Packing of Perianal Abscess Cavities (PPAC2) trial was a multicentre, RCT (two-group parallel design) of adult participants admitted to an NHS hospital for incision and drainage of a primary perianal abscess. Participants were randomized 1:1 (via an online system) to receive continued postoperative wound packing or non-packing. Blinded data were collected via symptom diaries, telephone, and clinics over 6 months. The objective was to determine whether non-packing of perianal abscess cavities is less painful than packing, without an increase in perianal fistula or abscess recurrence. The primary outcome was pain (mean maximum pain score on a 100-point visual analogue scale).<h4>Results</h4>Between February 2018 and March 2020, 433 participants (mean age 42 years) were randomized across 50 sites. Two hundred and thirteen participants allocated to packing reported higher pain scores than 220 allocated to non-packing (38.2 versus 28.2, mean difference 9.9; P < 0.0001). The occurrence of fistula-in-ano was low in both groups: 32/213 (15 per cent) in the packing group and 24/220 (11 per cent) in the non-packing group (OR 0.69, 95 per cent c.i. 0.39 to 1.22; P = 0.20). The proportion of patients with abscess recurrence was also low: 13/223 (6 per cent) in the non-packing group and 7/213 (3 per cent) in the packing group (OR 1.85, 95 per cent c.i. 0.72 to 4.73; P = 0.20).<h4>Conclusion</h4>Avoiding abscess cavity packing is less painful without a negative morbidity risk.<h4>Registration number</h4>ISRCTN93273484 (https://www.isrctn.com/ISRCTN93273484).<h4>Registration number</h4>NCT03315169 (http://clinicaltrials.gov).
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | PPAC2 Collaborators, Humans, Abscess, Rectal Fistula, Anus Diseases, Pain, Treatment Outcome, Drainage, Bandages, Adult |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Population Health Faculty of Health and Life Sciences > Institute of Population Health > School of Health Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 02 Feb 2024 10:31 |
| Last Modified: | 02 Feb 2024 10:31 |
| DOI: | 10.1093/bjs/znac225 |
| Open Access URL: | https://doi.org/10.1093/bjs/znac225 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3178287 |
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