Efficacy of conservative treatment of perianal abscesses in children and predictors for therapeutic failure

Abstract

<jats:p>Background: The optimal management of perianal abscess in children is controversial.Purpose: To evaluate the efficiency of conservative treatment of perianal abscess in children and identify parameters that predict therapy failure.Methods: All cases of children younger than 14 years of age with perianal abscesses between 2001–2016 were evaluated.Results: Of the 113 enrolled patients, 64 underwent subsequent surgery for advanced disease (primary surgery group). Conservative treatment was initiated in 49 patients (primary conservative group) but was stopped because of inefficiency in 25 patients, who were referred for surgery after a median 7.03 days (range, 2 to 16 days). The other 24 patients (48%) initially achieved complete remission after conservative treatment, but 10 were readmitted after a median 34 months (range, 3 to 145 months) with recurrent disease. There were no significant differences in permanent success after conservative treatment between infants (10 of 29, 34%) and older children (4 of 20 [20%], &lt;i&gt;P&lt;/i&gt;=0.122). Overall, conservative treatment alone was effective in only 14 of 113 patients. Recurrence after surgery occurred in 16 patients (25%) in the primary surgery group and 11 patients (22%) in the primary conservative group (&lt;i&gt;P&lt;/i&gt;=0.75). Univariate analysis of predictors for conservative treatment failure revealed inflammatory values (C-reactive protein and white blood count, &lt;i&gt;P&lt;/i&gt;=0.017) and abscess size (&lt;i&gt;P&lt;/i&gt;=0.001) as significant parameters, whereas multivariate analysis demonstrated that only abscess size (odds ratio, 3.37; &lt;i&gt;P&lt;/i&gt;=0.023) was significant.Conclusion: Conservative treatment of perianal abscess is permanently efficient in only a minority of children but is not associated with a higher recurrence rate after subsequent surgery. Abscess size is a predictor for therapy failure.</jats:p>

Incision and Drainage With Primary Fistulotomy of Perianal Abscess Is Safe and Effective in Neonates: A Long-Term Follow-Up Study

“…The rate of fistula (between the PA and the anal crypt) identified at the time of primary drainage varies widely in different studies. The percentage of communication between the PA and the internal (anal) opening was <20% (1,4,6,7,11) or more than 60% (25,27,(29)(30)(31)(32). Our results (approximately 80%) support the latter.…”

“…The management of PA in infants and children is controversial. It has traditionally been treated surgically by incision and drainage (ID) (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). However, in the past two decades, some studies have shown that the conservative management appears to be effective in selected cases (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23).…”

Management of perianal abscess and fistula-in-ano in infants and children

“…They concluded that local hygiene and systemic antibiotics without surgical drainage minimized fistula formation. Boenicke et al 8) described the efficiency of conservative treatment of perianal abscesses in children and predictors of therapy failure. However, there is some confusion regarding the definition of conservative treatment for perianal abscess.…”

“…In this article, the authors defined incision and drainage of the perianal abscess as surgical treatment and local care including hygiene, sitz bath, and antibiotics as conservative treatment. 8) However, other articles defined incision and drainage with local care of the perianal abscess as conservative treatment. 2) There are different opinions regarding use of antibiotics in the treatment of perianal abscess and fistula-in-ano in literature.…”

“…However, there is some confusion regarding the definition of conservative treatment for perianal abscess. In this article, the authors defined incision and drainage of the perianal abscess as surgical treatment and local care including hygiene, sitz bath, and antibiotics as conservative treatment [ 8 ]. However, other articles defined incision and drainage with local care of the perianal abscess as conservative treatment [ 2 ].…”