Outcomes of Various Interventions for First-Time Perianal Abscesses in Children

Abstract

Introduction. In children treated surgically for first-time perianal abscesses, discovery and excision of concomitant fistulas may also be warranted. Aim. To evaluate children of varying age after incision and drainage of first-time perianal abscesses, examining recurrences rates with and without search for a fistula. Method. A retrospective review was conducted, analyzing children (ages 0–15 years) treated for first-time perianal abscesses at a tertiary pediatric surgical center, with a minimum follow-up of 6 months. Results. A total of 104 patients subjected to 112 treatments for first-time perianal abscesses were eligible. Surgical procedures constituted 84 (75%) of treatments, searching for fistulas in 49 (58%). In 34 (69%), fistulas were confirmed and treated. In the surgically treated subset, the recurrence rate was higher if no attempt was made to exclude a fistula (46%), as opposed to confirmed absence of a fistula (27%) or concurrent fistulotomy (9%; p = 0.02). Younger patients showed a higher recurrence rate (12/26; 46%), compared with older counterparts (11/58; 19%) (p = 0.002). Conclusion. In children surgically treated for first-time perianal abscess, recurrence rates appear to be lowered by locating and treating coexisting fistulas.

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

“…[3][4][5][6][7] The superiority of surgical management, however, has not been established, and even with the appropriate technique and adequate drainage, the reported rates of recurrence and/or progression to fistula-in-ano reach 85%. 8,9 These findings have prompted attempts at conservative management, which was found to be successful in selected cases. 1,2,10 The aim of the present study was to evaluate the outcomes of conservative treatment for perianal abscess in selected infants.…”

Treatment of First-Time Perianal Abscess in Childhood, Balance Recurrence and Fistula Formation Rate with Medical Intervention

“…Perianal abscess is an anorectal disorder affecting both children and adults, 1 who may experience considerable discomfort. 2,3 A strong male predominance is evident, with peak onset at ages < 1 year. 4,5 One theory is that such abscesses in children arise from abnormal crypts of Morgagni.…”

“…These abnormal crypts are predisposed to infection and abscess formation, which may be cured, recur, or develop into fistula-in-ano. 1,2,4,6,7 Recurrences and/or development of fistula-in-ano (RF) rates after treatment of perianal abscess are reported in 0 to 85% of cases. This wide range may be due to therapeutic differences (i.e., conservative management vs. surgical intervention) or conventions in reporting and designating fistulas as recurrences or complications.…”

“…This wide range may be due to therapeutic differences (i.e., conservative management vs. surgical intervention) or conventions in reporting and designating fistulas as recurrences or complications. [1][2][3][4][6][7][8][9] Although conservative management is the most frequently used and first-opted approach, surgical intervention, which includes incision and drainage (ID), drainage change alone, or fistulotomy of first-time perianal abscess, may be needed if the conservative treatment cannot control the condition. In fact, the indication for surgical intervention remains obscure and controversial.…”

“…In fact, the indication for surgical intervention remains obscure and controversial. [1][2][3][4][6][7][8][9][10][11] The objective of this retrospective study was to investigate the clinical course and RF rates of first-time perianal abscesses in children < 15 years old, comparing outcomes in the aftermath of conservative management with those after surgical treatment.…”