This study focused on differences in the ethnical pattern of perianal abscess as well as its treatment in the Israel Negev population during an 11 year period. Eighty percent of the operations were performed on males, an observation consistent with previous findings in western countries
. This male gender predominance in perianal abscess has been reported also for other diseases of the lower gastrointestinal tract in different populations of Bedouin; however, the pathology of perianal abscess did not receive particular consideration
. The mean age of the Bedouin (males and females) who underwent surgical intervention was 8 years younger than the general population (p<0.001).
Ethnic differences between Israelis inhabiting same environment have been described for colorectal cancer in which the incidence of colorectal cancer among Arabs is 10 times lower than in Jews
. In contrast, we found that Bedouin males had more than twice relative risk (RR 2.27 95% CI 2.002 to 2.580) to develop perianal abscess. In contrast female RR was only 0.81 (95% CI 0.5724 to 1.152).
Factors such as diet and physical activity may play a role in the development of the disease as is strongly suggested by the difference in incidence rates between Jews and Arabs living in the same region. The traditional diet of Arab populations in Israel is richer in high residual elements than that of the Jews
. Arabs also engage in more extensive physical activity, a factor well recognized to affect the incidence of some diseases. Different dietary patterns of the Jewish and Arab population may play a role in the relatively higher occurrence of perianal abscess among Bedouin males. However, dietary differences are unlikely to be responsible for all the findings, since the relative risk among Bedouin female was the same as in the general population.
The initial approach to anorectal abscess is incision and drainage (ID). This is a simple procedure which can be performed by residents with a high rate of success and a low rate of complications. However, ID carries with it an increased risk of recurrence. To avoid recurrence, fistulotomy which is directed toward the pathophysiological process of abscess formation should be considered instead of incision and drainage. Nevertheless, fistulotomy is a much more complicated procedure than ID, should be performed by a trained proctologist, and carries a higher rate of morbidity.
In our study, patients were treated by ID; 16.6% of the patients experienced recurrence, a far lower rate than observed in previous reports
. Since Soroka Medical Center is the only referral hospital in southern Israel it is reasonable that we would encounter the entire population of patients, including those who experience recurrence. Therefore, we conclude that in our general population it is not justified to perform more than ID during the acute phase.