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Incision and drainage of cutaneous abscess with or without cavity packing: a systematic review, meta-analysis, and trial sequential analysis of randomised controlled trials

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Abstract

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.

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Author notes

    Authors and Affiliations

    1. Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK

      Ali Yasen Y. Mohamedahmed, Shafquat Zaman, Stephen Stonelake, Adil N. Ahmad, Uttaran Datta & Shahin Hajibandeh

    2. Department of General Surgery, Glan Clwyd Hospital, Rhyl, Denbighshire, UK

      Shahab Hajibandeh

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    1. Ali Yasen Y. Mohamedahmed
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    Contributions

    Conception and design: AYYM, SZ, SH; Literature search and study selection: AYYM, SZ; Data collection: AYYM, SZ, UD; Analysis and interpretation: AYYM, SS, SH; Writing the article: All authors; Critical revision of the article: All authors; Final approval of the article: All authors; Statistical analysis: AYYM, SZ.

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    Correspondence to Ali Yasen Y. Mohamedahmed.

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    The authors declare that they have no conflict of interest.

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    Considering the nature of this study, ethical approval was not required.

    Human and animal rights

    This study is a systematic review with meta-analysis of outcomes which does not include research directly involving human or animal participation.

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    Considering the nature of this study, informed consent was not required.

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    Ali Yasen Y. Mohamedahmed and Shafquat Zaman contributed equally to this work.

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    Mohamedahmed, A.Y.Y., Zaman, S., Stonelake, S. et al. Incision and drainage of cutaneous abscess with or without cavity packing: a systematic review, meta-analysis, and trial sequential analysis of randomised controlled trials. Langenbecks Arch Surg 406, 981–991 (2021). https://doi.org/10.1007/s00423-020-01941-9

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