Evaluation of the efficacy of incision and drainage versus hainosankyuto treatment for perianal abscess in infants: a multicenter study

Hanada, Manabu; Furuya, Takeshi; Sugito, Kiminobu; Ohashi, Keiji; Ikeda, Taro; Koshinaga, Tsugumichi; Kawashima, Hiroyuki; Inoue, Masatoshi; Hosoda, Toshifumi; Gotô, Hiroshi

doi:10.1007/s00595-014-1058-2

Cited by 19 publications

(13 citation statements)

References 15 publications

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“…Infant with perianal abscess seems to be a peculiar population. 2 We observed that infant perianal abscess frequently occurred in male infants under 3 months of age in our clinical practice. The recurrence of an abscess or the development of a fistula, after the incision of perianal abscess, is rare in infants when compared with adults.…”

Section: Discussionmentioning

confidence: 72%

“…The prevailing theories are the congenital theory, which implicates the excess production of androgens, and the one which is based on the existence of abnormal anal crypts. [2][3][4][5][6][7] The option of conservative treatment or surgery is often determined depending on personal preference of physicians rather than consensus guidelines. Surgical intervention includes incision and drainage, active probing for underlying fistulae and fistulotomy.…”

Section: Discussionmentioning

confidence: 99%

“…They are usually superficial entities close to the anus; however the variability in size, precise location, and relation to the anal sphincter system, in addition to the deficiency of information on underlying fistulae and the lack of contemporaneous ultrasound or magnetic resonance imaging studies, have contributed to the confusion and variability regarding treatments. 1,2 Thereby, until now, perianal abscess remains unclassified, without unanimous data regarding treatment and surgical techniques that should be adopted. Recurrence or development of fistula-in-ano rates after initial treatment of perianal abscess are reported in 0 to 85% of cases.…”

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confidence: 99%

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The pathogens and curative effects analysis of perianal abscess of infants under 3 months

Zhu

2019

Turk J Pediatr

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Zhu Y, Xu F. The pathogens and curative effects analysis of perianal abscess of infants under 3 months. Turk J Pediatr 2019; 61: 40-43.In order to guide clinical treatment for perianal abscess of young infants, the characteristics of pathogens and curative effects analysis were conducted. Bacterial culture results, antibiotics susceptibility tests and curative effects of abscess incision were retrospectively analyzed in 66 cases of perianal abscess of infants under 3 months. There were 48 cases of Klebsiella pneumoniae, 7 cases of Staphylococcus, 6 cases of Escherichia coli, 5 cases of Proteus in the pathogen culture results. Klebsiella pneumoniae, the predominant pathogen, was susceptible to most antibiotics, especially to imipenem, cefoperazonesulbactam and amikacin with low drug resistance rates. However, high drug resistance rates were found to ampicillin and nitrofurantion. After abscess incision, the complication rate of anal fistula was 6.6％ in infants under 3 months and 60.3％ in the adult group. There was significant difference P＜0.01. In conclusion, Klebsiella pneumoniae was the most common pathogen in perianal abscess of infants under 3 months and was commonly resistant to ampicillin and nitrofurantion. Since perianal abscess of infants under 3 months is a self-limited disorder, simple surgical intervention and synchronous sensitive antibiotic administration are suggested as the optimal management.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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The pathogens and curative effects analysis of perianal abscess of infants under 3 months

Zhu

2019

Turk J Pediatr

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“…Ohya et al . reported on the efficacy of Juzentaihoto in accelerating the recovery of fistula in‐ano through immune stimulation, while another herb mixture, Hainosankyuto , was found to be beneficial in the management and resolution of perianal abscess in infants through anti‐inflammatory and analgesic properties . Further prospective trails are required to establish treatment protocols.…”

Section: Discussionmentioning

confidence: 99%

Perianal abscess in infants: Amenable to conservative treatment in selected cases

Samuk

Avinadav

Barak

et al. 2019

Pediatrics International

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Background Perianal abscess is a common surgical condition in daily pediatric practice. Management is a subject of controversy and a variety of approaches are practiced. While the most frequent approach is drainage with/without fistulotomy, the superiority of this approach and the place of conservative approach has not been established. The aim of this study was to evaluate the outcomes of conservative approach in selected cases of perianal abscesses in infants. Methods Data of 19 patients aged <24 months treated conservatively for perianal abscess at a tertiary hospital in 2014–2018 were retrospectively reviewed. Results Criteria for a conservative approach were: spontaneous drainage into the anal canal (n = 8) or perianal skin (n = 4), and phlegmonous infiltrate with fluid collection detected on ultrasound (n = 7). Mean age at symptom onset was 8.4 months. Twelve patients were managed for the first time. Previous care in seven patients included 1–4 drainage procedures (n = 4), spontaneous drainage (n = 1) and antibiotics (n = 2). Five patients were on oral antibiotics at presentation. After diagnosis, 18 patients received i.v. antibiotics and one, oral antibiotics. Three patients (15.7%) ultimately required surgical drainage; two were lost to follow up. During follow up (mean, 22.4 months) four patients (28.5%) had a single recurrent episode; abscess in three (managed conservatively in two and surgically in one) and fistula‐in‐ano in one patient that healed spontaneously. Thus, surgical intervention was prevented in 13/17 patients (76.4%) available for follow up. Conclusions Perianal abscess in infants is amenable to conservative management in selected cases. Avoiding surgical intervention is advantageous, especially given the high recurrence rate.

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“…Hanada et al . compared PA treated using ID or TJ‐122 . Only one patient eventually required ID in the TJ‐122 group in their series.…”

Section: Discussionmentioning

confidence: 99%

Combination therapy with traditional medicines for perianal abscess in children

Sueyoshi¹,

Lane

Kusafuka³

et al. 2019

Pediatrics International

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Background: Combination therapy with two different traditional medicine formulations called hainosankyuto and juzentaihoto (TJ-122 and TJ-48; Tsumura & Co, Tokyo, Japan) may be effective for perianal abscess (PA), but their effectiveness has not been established. The present study investigated the effectiveness of combination therapy with TJ-122 and TJ-48 as the most effective conservative treatment for PA. Methods: We identified 69 patients with PA under 2 years of age and divided them into four groups according to the formulations used: group 1, TJ-122 (n = 17); group 2, TJ-48 (n = 14); group 3, TJ-122 and TJ-48 (n = 19); and group 4, no traditional medicines (n = 19). Treatment was continued for 3-6 months after resolution of the PA in groups 1 and 2, and for 1 year in group 3. Age at presentation, duration of purulent discharge (PD), frequency of surgical intervention (incision and drainage [ID]; fistulotomy/fistulectomy), and recurrence rates were statistically analyzed. Results: Mean age (months) was 8.6 AE 9.2, 6.9 AE 7.3, 5.2 AE 4.7, and 3.8 AE 3.1 in groups 1, 2, 3, and 4, respectively (P = n.s.). Mean PD (weeks) was 2.5 AE 2.2, 7.1 AE 10.8, 2.0 AE 0.0, and 2.7 AE 1.0, respectively. Duration of PD was significantly longer in group 2 than in groups 1 and 3 (P < 0.05). Mean number of ID procedures was 1.0 AE 0.2, 2.3 AE 0.5, 0, and 1.6 AE 0.2, respectively. Group 1 had significantly less ID than group 2 (P < 0.01). Recurrence rates were 6%, 36%, 0%, and 32%, respectively. Groups 1 and 3 had significantly less recurrence than group 2 (P < 0.05), and group 3 had significantly less recurrence than group 4 (P < 0.01). Conclusions: Combination therapy with TJ-122 and TJ-48 decreased recurrence and surgical intervention to zero in this study, demonstrating high effectiveness for treating PA in children.

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Evaluation of the efficacy of incision and drainage versus hainosankyuto treatment for perianal abscess in infants: a multicenter study

Abstract: TJ-122 treatment was more beneficial than ID in treating PA in infants.

Cited by 19 publications

References 15 publications

The pathogens and curative effects analysis of perianal abscess of infants under 3 months

The pathogens and curative effects analysis of perianal abscess of infants under 3 months

Perianal abscess in infants: Amenable to conservative treatment in selected cases

Combination therapy with traditional medicines for perianal abscess in children

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