Limited Incision-and-Drainage versus Conservative Management of Perianal Abscess in Infants

Abstract

Introduction: Perianal abscesses (PA) are common in infants, yet there is no consensus on optimal management. Approaches range from conservative management (CM) to surgical incision and drainage, with varying rates of recurrence and fistula formation. A significant challenge is the absence of both standardized definitions and a protocol driven approach to incision-and-drainage. This study aims to evaluate the outcomes of standardized limited incision-and-drainage (LID) and CM approaches in infantile perianal abscesses. Methods: This retrospective observational cohort study included infants less than 18 months of age who were treated for perianal abscess at a single pediatric surgical unit between August 2019 and August 2023. Patients who had been treated either with LID or CM protocols were compared. The primary outcomes were recurrence and fistula rates, while secondary outcomes included identifying potential risk factors for these complications. Results: A total of 61 abscesses in 51 infants were analyzed. No significant differences were found between LID and CM groups in terms of recurrence (33% vs. 29%, p=0.94) or fistula formation (30% vs. 25%, p=0.64). Bacterial cultures revealed antibiotic-resistant bacteria in 36% of cases, with resistant strains significantly associated with both recurrence (OR 9.28, p=0.0006) and fistula development (OR 5.00, p=0.010).  Conclusions: LID and CM protocols yield comparable outcomes in terms of recurrence and fistula formation in infants with PA. The strong association between antibiotic-resistant bacteria and these complications underscores the importance of early identification and targeted antimicrobial treatment. Further research is needed to refine antibiotic use and assess long-term outcomes.