Following basic investigations:
Anesthesia: Local with sedation or regional anesthesia
Position: Prone i.e. patient lying on the stomach or lithotomy
Procedure: The pus is aspirated and sent for culture and sensitivity. The incision is taken over the abscess and pus is drained after breaking all the loculi. The wall of the abscess cavity is excised and sent for histopathology. The unhealthy tissue is scooped out. if there is an existing connection with the anal canal i.e. fistula then fistulectomy is done in the same stage. After achieving hemostasis, the wound is washed and packed. The anal canal is packed.
Post op: Patient is given antibiotics, pain killers, stool softeners and local ointment for management of the wound. A specific dressing is taught which has to be followed. Also patients are given instruction regarding food habits and if a sitz bath is needed. Patients will experience pain for the first 2 to 3 days while passing motion which is relieved by medications. Patients can start work on the 3rd day and can have a routine lifestyle by 3rd or 4th week.
Follow up: Patient is followed up on 3rd or 4th day and then weekly till wound heals.