Non-operative Versus Operative Management of Perianal Abscess in Infants: A 10-year Retrospective Study at Two Centres in the United Kingdom
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Topic Overview
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.
Transcript
For infants with perianal abscess, it's a better to manage them operatively or non-operatively. I'm Lizzie Lee from Cincinnati Children's Hospital and this is an article you should know about. This retrospective cohort study looked at children less than 12 months old who underwent their first episode of perianal abscess at two pediatric surgery centers in the UK from 2012 to 2022. Forty-three patients were managed surgically with general anesthesia, incision, and drainage with some needing fist-jula treatment as well. 73 patients were managed non-surgically with antibiotics, bedside aspiration, and bedside drainage. They found that the non-operatively managed group of patients had a higher risk of abscess recurrence and needing subsequent surgery, but they did avoid general anesthesia. This study showed the superiority of surgical management for perianal abscess and infants, but decisions should weigh the risks of surgery and anesthesia against the risk of recurrence.