Mohamedahmed AYY, Zaman S, Stonelake S, Ahmad AN, Datta U, Hajibandeh S, Hajibandeh S, et al.
Langenbeck's archives of surgery. Date of publication 2021 Jun 1;volume 406(4):981-991.
1. Langenbecks Arch Surg. 2021 Jun;406(4):981-991. doi:
10.1007/s00423-020-01941-9. Epub 2020 Aug 1.
Incision and drainage of cutaneous abscess with or without cavity packing: a
systematic review, meta-analysis, and trial sequential analysis of randomised
controlled trials.
Mohamedahmed AYY(#)(1), Zaman S(#)(2), Stonelake S(2), Ahmad AN(2), Datta U(2),
Hajibandeh S(3), Hajibandeh S(2).
Author information:
(1)Department of General Surgery, Sandwell and West Birmingham Hospitals NHS
Trust, Birmingham, UK. dr.aliyasen1@gmail.com.
(2)Department of General Surgery, Sandwell and West Birmingham Hospitals NHS
Trust, Birmingham, UK.
(3)Department of General Surgery, Glan Clwyd Hospital, Rhyl, Denbighshire, UK.
(#)Contributed equally
AIMS: To evaluate comparative outcomes of incision and drainage of cutaneous
abscess with and without packing of the abscess cavity.
METHODS: A systematic search of multiple electronic data sources was conducted,
and all randomised controlled trials (RCTs) comparing incision and drainage of
cutaneous abscess with and without packing were included. Abscess recurrence at
maximum follow-up period, need for second intervention, and development of
fistula in-ano were the evaluated outcome parameters for the meta-analysis A
Trial Sequential Analysis was conducted to determine the robustness of the
findings.
RESULTS: Eight RCTs reporting a total number of 485 patients who underwent
incision and drainage of cutaneous abscess with (n = 243) or without (n = 242)
packing of the abscess cavity were included. There was no significant difference
in the risk of recurrence (risk ratio (RR) 1.31, P = 0.56), fistula-in-ano (RR
0.63, P = 0.28), and need for second intervention (RR 0.70, P = 0.05) between
two groups. The results remained unchanged on sub-group analyses for ano-rectal
abscess, paediatric patients, adult patients, and the use of antibiotics. The
Trial Sequential Analysis demonstrated that the meta-analysis was not
conclusive, and the results for recurrence were subject to type 2 error.
CONCLUSION: Incision and drainage of cutaneous abscess with or without packing
have comparable outcomes. However, considering the cost and post-operative pain
associated with packing, performing the procedure without packing of the abscess
cavity may be more favourable. The findings of the better quality ongoing RCTs
may provide stronger evidence in favour of packing or non-packing.
DOI: 10.1007/s00423-020-01941-9
PMID: 32740696 [Indexed for MEDLINE]
