Abstract

Qing Zhao, Lo Yau, Yanting Lou, Qi Hao Hou, Denis Mak Chi*, Marek Y. Nitsetskyi

ABSTRACT

Perianal abscesses represent a common and painful condition requiring prompt intervention to prevent complications such as fistula formation. This original randomized controlled study, conducted from January 2015 to December 2016 at the Department of Coloproctology, Weihaiwei People's Hospital in Weihai, Shandong, China, aimed to evaluate the effectiveness of standard treatment augmented with rectal suppositories containing streptokinase (15,000 IU) and streptodornase (1,250 IU) compared to standard treatment alone. Seventy patients were randomized into two groups of 35 each. Group 1 received standard treatment according to international guidelines, including incision and drainage, antibiotics, and supportive care. Group 2 received the same standard treatment plus the suppositories, administered based on disease severity: for severe cases, one suppository three times daily for the first three days, twice daily for the next three days, and once daily for the following three days; for moderate to mild cases, one suppository twice daily for the first three days, followed by once daily for four days or twice daily for two days. Outcomes included hospital stay duration, incidence of severe disease progression, complications, pain intensity via Visual Analog Scale (VAS), quality of life assessed by the MOS SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS), and serum levels of cytokines IL-1, IL-6, TNF-α, IL-4, IL-10, and TGF-β. Group 2 demonstrated significantly shorter hospital stays (7.6 ± 2.5 days vs. 10.3 ± 3.2 days, p < 0.01), lower rates of severe progression (17.1% vs. 31.4%, p < 0.05), fewer complications (11.4% vs. 22.8%, p < 0.05), reduced pain scores, improved PCS and MCS scores, and more favorable cytokine profiles at days 3, 6, and 9. Correlations revealed complex interrelationships among cytokines, pain, and quality of life metrics, with pro-inflammatory cytokines positively associated with VAS and negatively with PCS/MCS. Adjunctive use of these suppositories enhances clinical outcomes, modulates inflammatory responses, and improves patient quality of life in perianal abscess management.