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Comparison of different treatment modalities for perianal abscess in infants: a retrospective cohort study
Shuai Wang1, Peng Wang1, Lili Liu1
1Department of Anorectal Surgery, Affiliated Hospital of Jining Medical University, 129 Hehua Road, Jining, 272067, China.
Insights
Conservative management is recommended for infant perianal abscesses (PA). While incision and drainage with primary fistulotomy showed higher cure rates, conservative management offers a safe, effective first-line approach for infant PA.
Area of Science:
- Pediatric Surgery
- Infant Health
- Gastroenterology
Background:
- Perianal abscess (PA) management in infants is debated.
- Optimal treatment strategies require further investigation.
Purpose of the Study:
- To compare the efficacy of incision and drainage (ID), incision and drainage with primary fistulotomy (IDF), and conservative management (CM) for infant PA.
- To determine the safest and most effective treatment for perianal abscesses in infants under one year of age.
Main Methods:
- Retrospective cohort study of 597 infants with PA (2014-2020).
- Comparison of treatment groups: IDF (n=282), ID (n=162), and CM (n=153).
- Analysis of cure rates, complications, and follow-up data.
Main Results:
- The IDF group had a significantly higher cure rate (97.8%) compared to ID (82.1%) and CM (80.4%) groups (p < 0.001).
- No severe complications were noted in ID or CM groups; IDF group had 3 cases of sepsis.
- Perianal abscess in infants may be self-limiting, with CM being a viable option.
Conclusions:
- Conservative management (CM) should be considered the first-line approach for most infant perianal abscesses.
- While IDF shows higher cure rates, the potential risks of sepsis warrant careful consideration.
- Infant perianal abscesses can resolve without surgical intervention.
Abstract:
The optimal management of perianal abscess ( PA) in infants remains controversial. This study aimed to compare incision and drainage (ID), incision and drainage with primary fistulotomy (IDF), and conservative management(CM)for the treatment of infants with PA (< 1 year). A retrospective cohort study was conducted for infants with PA between 2014 and 2020. Patients undergoing IDF were assigned to the IDF group, those undergoing ID were assigned to the ID group, and those whose parents declined surgery were assigned to the CM group. A total of 597 patients were identified (591 boys and 6 girls); 282 in the IDF group, 162 in the ID group, and 153 in the CM group. The median age at first visit was 43 days (range 30-90 days). The median follow-up was 5.8 years (range 3-9.4 years). The baseline characteristics of the three groups were similar (except for abscess size, length of stay, and inpatient costs). The cure rate in the IDF group (97.8%, 276/282) was higher than that in the ID group (82.1%, 133/162; p < 0.001), and the CM group (80.4%, 123/153; p < 0.001). No severe complications were found in the ID or CM groups. The IDF group had 3 cases of sepsis, including 1 with a concurrent central nervous system infection. No fecal incontinence was observed in any of the patients. PA in infants may be a self-limiting disease. CM should be the first-line approach in most cases of PA in infants.
