Management of isolated deep postanal space suppuration via posterior sphincterotomy

Aim
The aim of this study was to evaluate the treatment of isolated deep postanal space (DPS) suppuration, using the posterior midline approach in terms of recurrence and post-drainage fistula formation.
Patients and methods
The study included 16 patients (13 men and three women) with isolated DPS suppuration without clinical or radiological evidence of extension. DPS affection was demonstrated by bidigital examination and preoperative MRI. All patients were managed by the posterior sphincterotomy approach performed by senior colorectal surgeons.
Results
Patients complained for a mean period of 23.75±19.43 days before seeking medical advice. There was great variability between duration in patients complaining of acute pain only (6.80±2.28 days) and chronic discharge only (31.40±14.09 days). Recurrence was encountered in two (12.5%) patients in the form of recurrent abscess (6.25%) that developed 3 months after the first drainage and anal fistula (6.25%) that developed 4 months postoperatively. Patients in the study reported satisfactory results with regard to postoperative continence after 3 months. These results showed further improvement at 6 and 12 months.
Conclusion
Isolated DPS suppuration should be managed with a senior colorectal surgeon. Without awareness of the problem and a clear understanding of anatomy, it is impossible to achieve successful treatment of the isolated DPS suppuration. Management of isolated DPS by the posterior sphincterotomy approach seems to be a successful technique with low recurrence rate and satisfactory postoperative continence status.