Combined Effect of Pre-Operative Antibiotics and Enema for Surgical Site Infection Prevention in Anorectal Surgery: A Retrospective Study

<b><i>Background:</i></b> There is no consensus on the optimal strategy for surgical site infection (SSI) prevention in anorectal surgery. Pre-operative antibiotic agents and enema are commonly used, but their effectiveness in SSI prevention has not been studied. The objective of this study was to determine the combined effect of antibiotic agents and enema on SSI rates in anorectal surgery for benign disease. <b><i>Methods:</i></b> A retrospective study was conducted between July 2015 and June 2024 in an academic institution on adult patients who underwent either elective excisional hemorrhoidectomy, lateral internal sphincterotomy (LIS), or simple fistulotomy. Patients were categorized into four groups on the basis of the pre-operative prophylactic strategy utilized: neither antibiotic agents nor enema, enema only, antibiotic agents only, or both antibiotic agents and enema. The primary outcome measured was the effect of pre-operative prophylactic strategy on reducing SSI rates, analyzed within the overall cohort and stratified by procedure performed. Other outcomes measured were factors associated with SSI development. <b><i>Results:</i></b> During the study period, 555 patients met the inclusion criteria. Of these, 136 (24.5%) patients received neither antibiotic agents nor enema, 65 (11.7%) received enema only, 217 (39.1%) received antibiotic agents only, and 137 (24.7%) received both antibiotic agents and enema. No significant differences were observed between the four groups with regard to age, gender, associated comorbidities, or smoking status. SSI occurred in 40 (7.2%) patients within the cohort; of these 3 (7.5%) patients required incision and drainage, and the remaining 37 (92.5%) patients were managed with antibiotic therapy. There was no difference in the SSI rate on the basis of the pre-operative prophylactic strategy utilized. Similarly, no difference was observed among the four groups when stratified by the procedure performed. <b><i>Conclusion:</i></b> Pre-operative antibiotic agents and enema, whether administered individually or in combination, showed no substantial effect on SSI rate.