Management of Perianal Abscesses in Infants: A Systematic Review From the APSA Outcomes and Evidence-Based Practice...

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Evidence-Based Medicine

Background:

• Management of infant perianal disease, including perianal abscess and fistula-in-ano (FIA), lacks consensus.
• Controversy exists regarding the optimal risks and benefits of operative versus non-operative approaches.

Purpose of the Study:

• To establish consensus-based questions on infant perianal abscess and FIA management.
• To systematically review evidence for various treatment strategies.

Main Methods:

• Systematic review of Level 3-4 studies following PRISMA guidelines.
• Comprehensive literature search to identify relevant manuscripts.
• Analysis of data on treatment outcomes for perianal disease in infants.

Main Results:

• Initial non-operative management (NOM) failure rate is ~37.5%.
• Recurrence rates after NOM or incision and drainage (I&D) are ~21% and ~24%, respectively.
• Recurrence after operative FIA management is ~7%; FIA development rates are ~20-21%.

Conclusions:

• Both operative and non-operative approaches are safe for infant perianal abscess and FIA.
• Recurrence is common irrespective of the chosen management strategy.
• Individualized risk-benefit assessment is crucial for treatment decisions.