481 Management of Perianal Abscess at Basildon and Thurrock University Hospital

Aim Perianal abscess is a common surgical presentation seen in the emergency secondary care setting; our aim is to evaluate the current surgical management at Basildon Hospital. Method A questionnaire was distributed amongst 24 surgical colleagues varying from consultants, registrars/SAS and core trainees to review their current management of perianal abscess. In conjunction, for comparison an audit was conducted of surgical operation notes for 35 perianal abscesses drained between April and September 2023. Results Following 17 responses to the questionnaire, the most common incision made was cruciate (41.20%), with radial being the least (11.80%). In addition, 47.10% reported documenting to continue packing post-operatively, with an equal proportion not doing so. Microbiology culture was routinely sent by 88.20% of respondents. In comparison, the audit concurred a cruciate incision was most commonly performed (25.71%), with radial, transverse and elliptical incisions equally the least performed (5.71%). Furthermore, 97.14% of cases had a post-operative plan instruction to continue regular packing, with this being dis-concordant with results of the questionnaire. In 91.42% of cases a microbiology culture was sent intra-operatively. Conclusions Amongst surgeons at Basildon variation exists in the incision utilised to drain perianal abscesses, however a circumanal incision is currently recommended by ACPGBI guidelines to avoid damage to external sphincters. Packing is persistently part of post-operative management plans despite studies demonstrating that this increases pain for patients as well as cost. The role of routine microbiology sampling must be reviewed in the department as it is of limited value in the management of patients with perianal abscess.