Non-operative Versus Operative Management of Perianal Abscess in Infants: A 10-year Retrospective Study at Two Centres in the United Kingdom

Infographic · Feb 2025 · 1 min read

In brief

Retrospective UK study of 116 infants with perianal abscess found operative management (incision and drainage) reduced recurrence rates to 23% versus 53% with non-operative treatment. Non-operative patients required significantly more subsequent surgeries, though fistula-in-ano rates were similar between groups.

Perianal abscess in infants managed operatively had 53% lower recurrence rate compared to non-operative management (23% vs 53%, p=0.001).
Non-operative management required significantly more subsequent surgeries (36% vs 16%, p=0.026) despite initial avoidance of anesthesia.
Fistula-in-ano development rates were similar regardless of initial treatment approach (32% non-operative vs 19% operative, p=0.129).
Operative management independently reduced recurrence risk by 75% (OR 0.25, 95% CI 0.09-0.68) in multivariate analysis.
Median recurrence time was only 1 month, suggesting early operative intervention may prevent multiple procedures in infant perianal abscess.

Written by the GCMD Library team from the infographic.

J.J. Neville, K. Humpleby, C. Healy, N.J. Hall, M.P. Stanton

Background: Perianal abscess (PA), with or without fistula-in-ano (FIA) is common in infants. Treatment options include incision and drainage under general anaesthesia or non-operative treatments, such as antibiotics and/or aspiration under local anaesthetic, which avoid the risks of surgery. Current management is based on surgeon preference due to a poor underlying evidence base. In this study we aimed to compare outcomes for non-operative and operative management of infant PA.

Methods: 10-year retrospective review (2012–2022) of infants aged ≤12 months presenting with PA to two paediatric surgery centres in the United Kingdom. Clinical features, management and outcome data were extracted from electronic records.

Results: 116 infants were identified; 113/116 (97 %) were male. Median age at presentation was 2 (IQR 1–6) months. Initial management was non-operative in 73/116 (63 %) and operative in 43/80 (37 %). Median follow-up was 3 (IQR 2–6) months. Recurrence occurred in 49/116 (42 %) at a median time of 1 (IQR 0–3) month and was significantly higher in the non-operative compared to the operative group (39/73 [53 %] versus 10/43 [23 %], p = 0.001). Operative management was independently associated with a reduced risk of PA recurrence (OR 0.25 [95 % confidence interval 0.09–0.68], p = 0.007). Further surgery was performed in 26/73 (36 %) in the non-operative group and 7/43 (16 %) in the operative group (p = 0.026). Subsequent FIA rates were not significantly different (23/73 [32 %] versus 8/43 [19 %], p = 0.129).

Conclusions: In this study, PA recurrence and the requirement for further operative intervention were significantly higher when a PA was initially managed non-operatively, although subsequent FIA rates were similar.