Perianal abscess in children: aiming for optimal management
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Updated: May 23, 2026
Posterior Approach for Debridement of the Psoas Abscess
Published on: March 2, 2020
Emily Buddicom1, Amy Jamieson, Spencer Beasley
1Department of Paediatric Surgery, Christchurch Hospital, Christchurch, New Zealand.
Insights
Treating pediatric perianal abscesses with incision and drainage alone leads to higher recurrence. Identifying and laying open the associated fistula during the initial surgery significantly reduces recurrence rates in children.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Infectious Disease Management
Background:
- Perianal abscess is a common pediatric condition with debated optimal surgical management.
- Incision and drainage (I&D) alone has a higher recurrence rate compared to I&D with fistula laying open.
Purpose of the Study:
- To determine the institutional recurrence rate of pediatric perianal abscess.
- To assess the association between fistula management and recurrence rates.
Main Methods:
- Retrospective review of pediatric perianal abscess cases over a 13-year period (1996-2009).
- Comparison of recurrence rates based on whether an associated fistula was identified and managed surgically.
- Data compared with published surgical series.
Main Results:
- A fistula was identified in 73% of patients.
- Recurrence occurred in 8% of patients where the fistula was identified and managed, versus 24% where it was not.
- A trend towards significance (P = 0.06) was observed.
Conclusions:
- Perianal abscess recurrence in children is linked to fistula identification and management during initial surgery.
- Treating perianal abscess with I&D alone increases recurrence risk.
- Optimal management includes abscess drainage and laying open the fistulous tract to minimize recurrence.
Background:
Perianal abscess is common in infants and children, yet the optimal surgical management is argued: incision and drainage alone is a simple procedure but is associated with a much higher recurrence rate than incision and drainage with simultaneous laying open of the associated fistula. This retrospective review established the institutional recurrence rate and its close association with how the fistula was managed at the initial operation.
Methods:
A retrospective review of all children requiring an operation for a perianal abscess over a 13-year period from 1996 to 2009 was performed. Data were compared with published series.
Results:
A fistula was sought in 89 of 91 (98%) patients, and identified in 66 (73%). Recurrence occurred in 5/66 (8%) in whom a fistula was identified at the initial operation, compared with 6/25 (24%) (P = 0.06) in whom a fistula was not identified.
Conclusion:
Recurrence of perianal infection is influenced by whether a fistula was identified and laid open at the initial operation. The recurrence rate is higher when the abscess is treated with incision and drainage alone. Given the ease with which most fistulae may be identified, and laid open without morbidity, optimal treatment involves drainage of the abscess and laying open of the fistulous tract.
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