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Non-operative Versus Operative Management of Perianal Abscess in Infants: A 10-year Retrospective Study at Two
J J Neville1, K Humpleby2, C Healy3
1Department of Paediatric Surgery, Southampton Children's Hospital, University Hospitals Southampton NHS Foundation Trust, Southampton, UK; Department of Paediatric Surgery, Royal Alexandra Children's Hospital, Brighton, UK; University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK.
Insights
Infant perianal abscess (PA) management: Operative treatment significantly reduces recurrence and further surgery compared to non-operative approaches. Fistula-in-ano rates remain similar regardless of initial PA treatment.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Infant Health
Background:
- Perianal abscess (PA) and fistula-in-ano (FIA) are common in infants.
- Current PA management lacks robust evidence, relying on surgeon preference.
- Treatment options include operative (incision and drainage) and non-operative (antibiotics, aspiration) methods.
Purpose of the Study:
- To compare outcomes of non-operative versus operative management for infant perianal abscess (PA).
- To evaluate recurrence rates, need for further surgery, and fistula-in-ano development.
Main Methods:
- Retrospective review of 116 infants (≤12 months) with PA over 10 years (2012-2022).
- Data collected from two UK pediatric surgery centers.
- Analysis of clinical features, management strategies, and patient outcomes.
Main Results:
- Operative management was associated with significantly lower PA recurrence rates (23% vs. 53%, p=0.001).
- Infants managed operatively required less subsequent surgery (16% vs. 36%, p=0.026).
- Rates of subsequent fistula-in-ano (FIA) did not differ significantly between groups (19% vs. 32%, p=0.129).
Conclusions:
- Initial non-operative management of infant perianal abscess (PA) leads to higher recurrence and re-operation rates.
- Operative intervention is independently associated with reduced PA recurrence risk.
- Fistula-in-ano (FIA) development rates are comparable irrespective of initial PA treatment.
Background:
Perianal abscess (PA), with or without fistula-in-ano (FIA) is common in infants. Treatment options include incision and drainage under general anaesthesia or non-operative treatments, such as antibiotics and/or aspiration under local anaesthetic, which avoid the risks of surgery. Current management is based on surgeon preference due to a poor underlying evidence base. In this study we aimed to compare outcomes for non-operative and operative management of infant PA.
Methods:
10-year retrospective review (2012-2022) of infants aged ≤12 months presenting with PA to two paediatric surgery centres in the United Kingdom. Clinical features, management and outcome data were extracted from electronic records.
Results:
116 infants were identified; 113/116 (97 %) were male. Median age at presentation was 2 (IQR 1-6) months. Initial management was non-operative in 73/116 (63 %) and operative in 43/80 (37 %). Median follow-up was 3 (IQR 2-6) months. Recurrence occurred in 49/116 (42 %) at a median time of 1 (IQR 0-3) month and was significantly higher in the non-operative compared to the operative group (39/73 [53 %] versus 10/43 [23 %], p = 0.001). Operative management was independently associated with a reduced risk of PA recurrence (OR 0.25 [95 % confidence interval 0.09-0.68], p = 0.007). Further surgery was performed in 26/73 (36 %) in the non-operative group and 7/43 (16 %) in the operative group (p = 0.026). Subsequent FIA rates were not significantly different (23/73 [32 %] versus 8/43 [19 %], p = 0.129).
Conclusions:
In this study, PA recurrence and the requirement for further operative intervention were significantly higher when a PA was initially managed non-operatively, although subsequent FIA rates were similar.
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