Perianal abscess in children: aiming for optimal management

Abstract

Recurrence of perianal infection is influenced by whether a fistula was identified and laid open at the initial operation. The recurrence rate is higher when the abscess is treated with incision and drainage alone. Given the ease with which most fistulae may be identified, and laid open without morbidity, optimal treatment involves drainage of the abscess and laying open of the fistulous tract.

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

“…The unacceptably high recurrence rates of abscess and/or fistula after surgical drainage of a perianal abscess in infants (33-85%) 3,5,8,9 has led some authors to advocate an active search for fistula and fistulotomy with or without cryptotomy at the time of surgical drainage, in an attempt to reduce the need for repeated surgery for recurrent suppuration. 3,7,9,12,13 This could, however, subject patients who would not have acquired a recurrent abscess to an unnecessary radical procedure. 14 Moreover; there is a risk of complications such as iatrogenic fistula by probing the abscess, 15 or incontinence.…”

“…The traditional and still most frequent approach is immediate surgical drainage before the abscess "points" in order to prevent extension of the purulent material and loss of healthy tissue. [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.…”

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

“…The choice between conservative treatment and ID is often based on treating physician's personal preference rather than established guidelines. [2][3][4]10,11,14,15 Our protocol for treating perianal abscess consisted of primary conservative and surgical treatment (►Fig. 4).…”

“…In our series, the overall RF rate of 17.5% (82.5% cured) was lower than that of 20 to 85% noted in most series that adopted the ID surgical procedure as the first choice (75% incision). 1,2,[7][8][9]14 In some series, concurrent fistulotomy was adopted for first-time perianal abscess, resulting in recurrence rates ranging from 0 to 9%, but this operation was usually performed with patients under general anesthesia, 2,11 whereas ID required only local anesthesia and can be performed in the outpatient unit.…”

“…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.…”