Perianal Abscess Treatment in Infants – Can Conservative Treatment Improve Outcome?

Abstract:

Introduction: Perianal abscess (PA) and fistula-in-ano (FIA) are common conditions affecting infants and addressed collectively as one disease PA-FIA. They have a peak onset in infants, with strong male predominance. The clinical presentation varies widely from asymptomatic presentation to PA, therefore a variety of treatments exists for PA-FIA. Traditionally the treatment was surgical by incision and drainage. A high recurrence of PA-FIA suggested that conservative treatment improve outcome.

Method: An analytic retrospective review study was conducted for infants under two-years-old suffering PA-FIA that were treated at the Pediatric Department in Ziv Medical Center, between 2008 to 2019. During 2013, the department treatment guidelines changed, from surgical to the conservative approach, which resulted in two well-defined groups.

Results: Sixty-five infants diagnosed with first time PA-FIA were included. All patients were males, 90.7% under one-year-old. Thirty-four patients were treated surgically and 31 infants were treated conservatively. Eight patients had no response to conservative treatment and eventually were treated surgically. Complication rate, mainly PA recurrence, was 29.4% for the surgically treated group, and 26% for the conservatively treated group (p>0.05). Patient`s subgroup that had spontaneous drainage while treated conservatively had the lowest recurrence rate (p=0.021).

Conclusions: Perianal abscess-FIA usually develops in healthy male infants younger than one-year-old. This study does not show a statistical difference between surgical and conservative treatments regarding disease recurrence. However, when spontaneous drainage occurs during conservative treatment, the recurrence of PA-FIA is the lowest, suggesting that the natural course of the disease is the better one.