Packing of Perianal Abscess Cavities

NCT ID: NCT03315169

Last Updated: 2020-09-09

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

433 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-02-14

Study Completion Date

2020-06-12

Brief Summary

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The aim of this trial is to compare internal wound packing to no packing in postoperative management following incision and drainage of perianal abscess. Participants will be randomised 1:1 to either the packing or non-packing arm.

Detailed Description

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Perianal abscess is common, affecting 18,000 patients annually in England. Management has remained largely unchanged for over 50 years, and comprises surgical incision and drainage followed by continued internal wound dressing (packing) until healed. Packing is thought to reduce the rate of recurrent abscess and perianal fistula; a known complication of perianal abscess. Perianal fistula frequently requires multiple operations to resolve. The evidence for postoperative packing is limited¹ and may expose patients to painful procedures with no clinical benefit, and at considerable increased cost².

A multi-centre observational study of outcomes after drainage of perianal abscess (PPAC²) (n=141) found packing to be painful (2-3 fold increase in Visual Analogue Score pain scores during packing) and costly (estimated cost of £280 per patient; overall cost in the United Kingdom of £5 million annually). Fistula rate was 27%.

This study is a randomised controlled trial designed to assess whether there are differences between non-packing and packing of the perianal abscess cavity in terms of the short term negative effects of packing (pain, quality of life, return to work) whilst assessing the impact on key clinical outcomes (wound healing, fistulae formation) and resource use/cost.

All participants will be required to complete pain diaries following discharge from hospital. Clinical follow up to assess healing and other key clinical outcomes will take place at 4, 8 (if not healed at 4 weeks) and 26 weeks. Further data will be collected from National Health Service Registries at 52 weeks in order to assess abscess recurrences and fistulae formation.

Conditions

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Perianal Abscess Perianal Infections Peri Rectal Abscess Abscess; Anus Abscess Anorectal

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors
Note that only the clinician assessing healing and fistulae are masked.

Study Groups

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Packing of perianal abscess cavity

Internal packing of perianal abscess cavity as per normal practice.

Group Type ACTIVE_COMPARATOR

Packing of perianal abscess cavity

Intervention Type OTHER

Internal packing of perianal abscess cavity - standard treatment.

External dressing

External application of a non-adherent dressing to the perianal abscess cavity.

Group Type EXPERIMENTAL

External dressing

Intervention Type OTHER

Application of external dressing whilst perianal abscess cavity heals.

Interventions

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External dressing

Application of external dressing whilst perianal abscess cavity heals.

Intervention Type OTHER

Packing of perianal abscess cavity

Internal packing of perianal abscess cavity - standard treatment.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

1. Aged 18 or over
2. Undergoing surgical incision and drainage of a primary perianal abscess

Exclusion Criteria

1. Suspected inflammatory bowel disease
2. Fournier's Gangrene
3. Horseshoe (bilateral) abscess
4. Fistula-in-ano
5. Multiple abscess
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Liverpool

OTHER

Sponsor Role collaborator

Northwest Research Collaborative

UNKNOWN

Sponsor Role collaborator

University of Birmingham

OTHER

Sponsor Role collaborator

National Institute for Health Research, United Kingdom

OTHER_GOV

Sponsor Role collaborator

Manchester University NHS Foundation Trust

OTHER_GOV

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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James Hill, FRCS

Role: PRINCIPAL_INVESTIGATOR

Manchester University NHS Foundation Trust

Locations

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Salford Royal Hospital

Salford, Greater Manchester, United Kingdom

Site Status

West Middlesex University Hospital (Isleworth)

Isleworth, Middlesex, United Kingdom

Site Status

John Radcliffe Hospital

Oxford, Oxfordshire, United Kingdom

Site Status

Mew Cross Hospital

Wolverhampton, West Midlands, United Kingdom

Site Status

Huddersfield Royal Infirmary

Huddersfield, West Yorkshire, United Kingdom

Site Status

Pindersfields General Hospital

Wakefield, West Yorkshire, United Kingdom

Site Status

Salisbury District Hospital

Salisbury, Wiltshire, United Kingdom

Site Status

Aberdeen Royal Infirmary

Aberdeen, , United Kingdom

Site Status

Bangor Hospital, Betsi Cadwaladr University Health Board

Bangor, , United Kingdom

Site Status

Furness General Hospital

Barrow in Furness, , United Kingdom

Site Status

Royal United Hospital Bath NHS Foundation Trust

Bath, , United Kingdom

Site Status

Birmingham Heartlands Hospital

Birmingham, , United Kingdom

Site Status

Queen Elizabeth Hospital Birmingham

Birmingham, , United Kingdom

Site Status

Royal Blackburn Hospital

Blackburn, , United Kingdom

Site Status

Blackpool Victoria Hospital

Blackpool, , United Kingdom

Site Status

Royal Bolton Hospital

Bolton, , United Kingdom

Site Status

Bristol royal Infirmary, University Hospitals Bristol

Bristol, , United Kingdom

Site Status

Southmead Hospital North Bristo; NHS Trust

Bristol, , United Kingdom

Site Status

Addenbrooke's Hospital

Cambridge, , United Kingdom

Site Status

University Hospital of Wales (Cardiff)

Cardiff, , United Kingdom

Site Status

Broomfield Hospital

Chelmsford, , United Kingdom

Site Status

Countess of Chester

Chester, , United Kingdom

Site Status

Chesterfield Royal Hospital NHS Foundation Trust

Chesterfield, , United Kingdom

Site Status

University Hospitals Coventry and Warwickshire

Coventry, , United Kingdom

Site Status

Royal Devon & Exeter Hospital

Exeter, , United Kingdom

Site Status

Victoria Hospital (Fife)

Kirkcaldy, , United Kingdom

Site Status

Royal Lancaster Infirmary

Lancaster, , United Kingdom

Site Status

Aintree Hospital

Liverpool, , United Kingdom

Site Status

Royal Liverpool and Broadgreen University Hospitals NHS Trust

Liverpool, , United Kingdom

Site Status

Royal Glamorgan Hospital

Llantrisant, , United Kingdom

Site Status

Macclesfield District General Hospital

Macclesfield, , United Kingdom

Site Status

Manchester Royal Infirmary

Manchester, , United Kingdom

Site Status

Wythenshawe Hospital

Manchester, , United Kingdom

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Queen Elizabeth The Queen Mother Hospital

Margate, , United Kingdom

Site Status

Newcastle Upon Tyne University Hospitals NHS Foundation Trust

Newcastle, , United Kingdom

Site Status

Royal Gwent Hospital

Newport, , United Kingdom

Site Status

Norfolk and Norwich University Hospital

Norwich, , United Kingdom

Site Status

Nottingham University Hospitals NHS Trust

Nottingham, , United Kingdom

Site Status

Royal Alexandra Hospital

Paisley, , United Kingdom

Site Status

Plymouth Hospitals NHS Trust Derriford Hospital

Plymouth, , United Kingdom

Site Status

Portsmouth Hospitals NHS Trust

Portsmouth, , United Kingdom

Site Status

Sheffield Teaching Hospitals NHS Foundation Trust

Sheffield, , United Kingdom

Site Status

Southampton General Hospital

Southampton, , United Kingdom

Site Status

Arrowe Park Hospital

Upton, , United Kingdom

Site Status

Warrington Hospital

Warrington, , United Kingdom

Site Status

Warwick Hospital, South Warwickshire NHS Foundation Trust

Warwick, , United Kingdom

Site Status

Sandwell Hospital, SWBH NHS Trust

West Bromwich, , United Kingdom

Site Status

Royal Albert and Edward Infirmary

Wigan, , United Kingdom

Site Status

Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board

Wrexham, , United Kingdom

Site Status

Yeovil District Hospital

Yeovil, , United Kingdom

Site Status

Countries

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United Kingdom

References

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Smith SR, Newton K, Smith JA, Dumville JC, Iheozor-Ejiofor Z, Pearce LE, Barrow PJ, Hancock L, Hill J. Internal dressings for healing perianal abscess cavities. Cochrane Database Syst Rev. 2016 Aug 26;2016(8):CD011193. doi: 10.1002/14651858.CD011193.pub2.

Reference Type BACKGROUND
PMID: 27562822 (View on PubMed)

Pearce L, Newton K, Smith SR, Barrow P, Smith J, Hancock L, Kirwan CC, Hill J; North West Research Collaborative. Multicentre observational study of outcomes after drainage of acute perianal abscess. Br J Surg. 2016 Jul;103(8):1063-8. doi: 10.1002/bjs.10154. Epub 2016 Apr 7.

Reference Type BACKGROUND
PMID: 27061287 (View on PubMed)

Newton K, Dumville J, Briggs M, Law J, Martin J, Pearce L, Kirwan C, Pinkney T, Needham A, Jackson R, Winn S, McCulloch H, Hill J; PPAC2 Collaborators. Postoperative Packing of Perianal Abscess Cavities (PPAC2): randomized clinical trial. Br J Surg. 2022 Sep 9;109(10):951-957. doi: 10.1093/bjs/znac225.

Reference Type DERIVED
PMID: 35929816 (View on PubMed)

Other Identifiers

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PB-PG-0815-20037

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

R04689

Identifier Type: -

Identifier Source: org_study_id

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