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Outcomes of Various Interventions for First-Time Perianal Abscesses in Children
Alexander Juth Karlsson1, Martin Salö2, Pernilla Stenström2
1Faculty of Medicine, Institution of Clinical Science, Lund University, 221 85 Lund, Sweden.
Insights
Searching for fistulas during surgery for first-time perianal abscesses in children can lower recurrence rates. Prompt treatment of these fistulas is key to better outcomes.
Area of Science:
- Pediatric Surgery
- Colorectal Surgery
- Pediatric Gastroenterology
Background:
- First-time perianal abscesses in children often require surgical intervention.
- Concomitant anal fistulas may be present and warrant investigation during abscess treatment.
Purpose of the Study:
- To evaluate recurrence rates in children after surgical incision and drainage of first-time perianal abscesses.
- To compare recurrence rates with and without a systematic search for fistulas.
Main Methods:
- Retrospective review of 104 children (ages 0-15) treated for first-time perianal abscesses.
- Analysis of surgical treatments, including fistula detection and management.
- Minimum follow-up of 6 months.
Main Results:
- Fistulas were found and treated in 69% of cases where a search was performed.
- Recurrence rates were significantly higher when fistulas were not sought (46%) compared to when they were treated (9%).
- Younger children (<15 years) exhibited higher recurrence rates than older children.
Conclusions:
- Locating and treating coexisting fistulas during surgical management of pediatric perianal abscesses reduces recurrence.
- Age is a factor in recurrence rates, with younger children experiencing higher rates.
Introduction:
In children treated surgically for first-time perianal abscesses, discovery and excision of concomitant fistulas may also be warranted.
Aim:
To evaluate children of varying age after incision and drainage of first-time perianal abscesses, examining recurrences rates with and without search for a fistula.
Method:
A retrospective review was conducted, analyzing children (ages 0-15 years) treated for first-time perianal abscesses at a tertiary pediatric surgical center, with a minimum follow-up of 6 months.
Results:
A total of 104 patients subjected to 112 treatments for first-time perianal abscesses were eligible. Surgical procedures constituted 84 (75%) of treatments, searching for fistulas in 49 (58%). In 34 (69%), fistulas were confirmed and treated. In the surgically treated subset, the recurrence rate was higher if no attempt was made to exclude a fistula (46%), as opposed to confirmed absence of a fistula (27%) or concurrent fistulotomy (9%; p = 0.02). Younger patients showed a higher recurrence rate (12/26; 46%), compared with older counterparts (11/58; 19%) (p = 0.002).
Conclusion:
In children surgically treated for first-time perianal abscess, recurrence rates appear to be lowered by locating and treating coexisting fistulas.
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