Conventional incision and drainage was compared with incision plus curettage and primary suture of abscess cavity under antibiotic cover in a prospective, randomized trial of 83 patients with acute anorectal abscess with or without low fistula. All the patients were followed up for three years. The time to healing was on average three weeks less after suture than after incision alone. The difference was statistically significant. Primary healing was obtained in 32 of 42 cases after suture. Recurrence of abscess tended to be more frequent after suture, but the time to healing of initial and recurrent abscesses and fistulas in the three-year observation period continued to be three weeks less after suture than after incision alone, making suture the most attractive treatment.