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Perianal abscess in children: aiming for optimal management
Emily Buddicom1, Amy Jamieson, Spencer Beasley
1Department of Paediatric Surgery, Christchurch Hospital, Christchurch, New Zealand.
ANZ Journal of Surgery
|April 18, 2012
Summary
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.
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