Some patients with perianal abscesses may require a second surgery, while most patients with abscesses that are infected may not be particularly serious and can be solved relatively simply all at once. However, for patients with larger abscesses and deeper infections, secondary or tertiary surgery may be required. Usually, the first surgery is performed by incision and drainage, and after a period of time, the perianal abscess will form a fistula, and after a few months, the fistula is resolved together with the internal opening, which is the second surgery. However, in some patients, the fistula may not be cut at once because it crosses the anal sphincter more, and the cut may lead to anal incontinence, and then the fistula may need to be threaded. There are two types of fistula stitches: virtual stitches and real stitches. The virtual stitches require a single surgery to completely resolve, but the virtual stitches may not be particularly painful for the patient because they are not strangling the anal sphincter. In the case of solid hanging wire, the chronic cutting of the anal sphincter is usually done by the gradual strangulation of the rubber band, which may cause pain and swelling in the anus for a period of time after surgery. Overall, most perianal abscesses can be resolved in a single operation, but for perianal abscesses that are higher in location, deeper in abscess, larger in extent, and where the internal opening is not particularly clear, secondary or multiple operations may be required.