A Prospective Multicentre Randomized Controlled Study Of Three-cavity Clearance(TCC) In The Management Of Cryptoglandular Perianal Abscess

Objective:Three-cavity clearance(TCC)is an innovative technique proposed based on the physiological and pathological process of perianal abscess.This multicenter randomized controlled study was conducted to clarify the safety and effectiveness of three-cavity clearance in the management of cryptoglandular perianal abscess.Methods:The study was conducted in the second affiliated hospital of Nanjing University of Traditional Chinese Medicine,Rugao Traditional Chinese Medicine hospital,Lianyungang Traditional Chinese Medicine hospital,Changshu Traditional Chinese Medicine hospital and Shuyang Traditional Chinese Medicine hospital.Adopting the multicenter,prospective,randomized,parallel and controlled research method,inpatients with perianal abscess diagnosed and treated in the department of colorectal surgery of 5 hospitals were selected as the research objects.They were randomly divided into the TCC group(three-cavity clearance group)and control group(simple incision and drainage group).The primary outcome measures were the anal fistula formation rate and anal incontinence(Wexner score),and the secondary outcome measures were abscess recurrence,postoperative pain(VAS score),wound healing time and hospitalization duration.Results:A total of 334 patients with perianal abscess who were treated from September 2018 to September 2019 were included in this study.They were divided into the TCC group(n=162)and the control group(n=172).The difference in general information(age,gender,abscess site)between the TCC group and the control group was not significant(P>0.05).The anal fistula rate and abscess recurrence rate were 6.2%and 1.9%in TCC group and 18.0%and 8.1%in control group(P<0.05).No patients experienced fecal incontinence.On day 3 after surgery,the VAS score of TCC group was significantly lower than that of the control group(P<0.05).While there was no significant differences in the postoperative VAS score between the two groups on days 0(operative day),1,2,and 7(P>0.05).The hospitalization duration of TCC group and control group were 9.0±5.4 days and 10.4±6.1 days respectively,and the difference between the two groups was statistically significant(P<0.05).The wound healing time was 27.1±16.4 days in TCC group and that of the control group was 28.2±14.1 days,with no statistically significant difference(P>0.05).Conclusion:The prospective multicentre randomized controlled study showed that three-cavity clearance is a safe and effective management of cryptoglandular perianal abscess,which has the advantages of low anal fistula formation rate,less abscess recurrence,less postoperative pain,and no anal sphincter injury.