PURPOSE: Perianal sepsis is traditionally treated by incision and drainage, wi th packing of the residual cavity until healing. This study was designed to show that perianal abscess may be safely treated by incision and drainage alone. MET HODS: Healing times, analgesic requirements, pain scores, abscess recurrence, an d fistula rates were compared between two randomized groups treated with and wit hout packing of perianal abscess cavities. RESULTS: Fifty patients were recruite d (7 lost to follow-up): 20 in the packing and 23 in the nonpacking arm. The gr oups were comparable in terms of age and gender distribution, type and size of a bscess, and the presence of a fistula at operation. Mean healing times were simi lar (P = 0.214). The rate of abscess recurrence was similar (P = 0.61). Postoper ative fistula rates were similar (P = 0.38). Pain scores at the first dressing c hange were similar (P = 0.296). Although pain scores appeared much reduced in th e nonpacking arm, this did not attain statistical significance. CONCLUSIONS: Our pilot study indicates that perianal abscesses can be managed safely without con tinued packing of the cavity without any obvious complications. PURPOSE: Perianal sepsis is traditionally treated by incision and drainage, wi th packing of the residual cavity until healing. This study was designed to show that perianal abscess may be safely treated by incision and drainage alone. MET HODS: Healing times, analgesic requirements, pain scores, abscess recurrence, an d fistula rates were compared between two randomized groups treated with and wit hout packing of perianal abscess cavities. RESULTS: Fifty patients were recruite d (7 lost to follow-up): 20 in the packing and 23 in the non-packing arm. The gr oups were comparable in terms of age and gender distribution, type and size of a bscess, and the presence of a fistula at operation. Mean healing times were simi lar (P = 0.214). The rate of abscess recurrence Pain scores at the first dressing c hange were similar (P = 0.296). Although pain scores were much reduced in th e nonpacking arm, this did not a ttain statistical significance. CONCLUSIONS: Our pilot study indicates that perianal abscesses can be managed safely without con tinued packing of the cavity without any obvious complications.