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Surgical management of perianal abscess in neonates and infants
Sharman P Tan Tanny1, Naveen Wijekoon1, Ramesh M Nataraja1,2
1Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Victoria, Australia.
Background:
The optimal management of perianal abscess in neonates and infants remains unclear, including the need for laying open of the fistula and the role of microscopy and culture studies (MCS). We aimed to report the recurrence rate following incision and drainage alone (I&D) compared to incision and drainage with laying open of the fistula (I&DF) and to determine the value of MCS in perianal abscess management.
Methods:
Following ethical approval (16326Q), a 10-year (2007-2017) review of children younger than 1 year presenting with a perianal abscess was performed. Presence of a fistula was sought in all patients. Data are presented as number of cases (%), median (range) and analysed using Fisher's exact test and Mann-Whitney U-test. P-values of <0.05 were considered significant.
Results:
We identified 108 patients (107 (99.1%) males) with 111 abscesses (three bilateral); 26 in I&D group and 85 in I&DF group. Initial abscess occurred to the right of midline in 64 cases (58%) and to the left of midline in 47 cases (42%). Twenty-two (20%) recurred after 30 (6-372) days. Sixty-five (59%) had MCS performed. Recurrence was higher in I&D group (9/26) versus I&DF group (13/85) (P = 0.04 (relative risk 2.2, 95% confidence interval 1.0-4.5)). There was no difference in recurrence within each group between patients with or without MCS (I&D group, P = 0.1; I&DF group, P = 0.3).
Conclusion:
The recurrence of surgically managed perianal abscess is lower when a fistula is identified and laid open at the initial operation. There is little value of MCS in the management of paediatric perianal abscess.
Insights
Surgical management of infant perianal abscesses is improved by laying open fistulas, reducing recurrence. Microscopy and culture studies (MCS) show little value in managing these pediatric cases.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Surgical Infections
Background:
- Optimal management of perianal abscess in neonates and infants is not well-defined.
- The role of fistula treatment and diagnostic studies like microscopy and culture studies (MCS) requires clarification.
Purpose of the Study:
- To compare recurrence rates between incision and drainage alone (I&D) versus I&D with fistula laying open (I&DF).
- To evaluate the utility of MCS in managing infant perianal abscesses.
Main Methods:
- A 10-year retrospective review of infants (<1 year) with perianal abscesses.
- Data collected on fistula presence, treatment type (I&D vs. I&DF), and MCS use.
- Statistical analysis using Fisher's exact test and Mann-Whitney U-test.
Main Results:
- 108 infants (99% male) were included; 26 in I&D and 85 in I&DF groups.
- Recurrence rate was significantly lower in the I&DF group (P=0.04).
- MCS did not impact recurrence rates in either treatment group (P=0.1 for I&D, P=0.3 for I&DF).
Conclusions:
- Laying open identified fistulas during initial surgery reduces perianal abscess recurrence in infants.
- Microscopy and culture studies (MCS) offer minimal benefit in the management of pediatric perianal abscesses.
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