Management of perianal abscesses in infants without general anaesthesia: a systematic review of the literature

Stokes, Rachael; Wanaguru, Dylan; Saadi, Alend; Adams, Susan

doi:10.1007/s00383-020-04728-7

Cited by 11 publications

(11 citation statements)

References 27 publications

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“…7,8 With a clear predominance of males, most children have the onset of PA in the first year of life. 9,10 Various therapies have been applied, while decision-making on choosing the treatment depends on the experiences and judgments provided by physicians, as well as the tendency of caregivers. Nonoperative management will be more acceptable due to its safety and efficacy, while prompt incision and drainage (I&D) still should be implemented for abscesses with significant fluctuation, which provoke pain or systemic signs of sepsis and cannot discharge spontaneously.…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, several predisposing disorders may also be responsible for the development of an abscess, such as inflammatory bowel disease (IBD), anorectal malformations, and immunodeficiency 7,8 . With a clear predominance of males, most children have the onset of PA in the first year of life 9,10 . Various therapies have been applied, whilst decision-making on choosing the treatment depends on the experiences and judgments provided by physicians, as well as the tendency of caregivers.…”

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confidence: 99%

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A Systematic Review and Meta-Analysis of Comparing Drainage Alone versus Drainage with Primary Fistula Treatment for the Perianal Abscess in Children

et al. 2023

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Background This systematic review and meta-analysis of non-randomized studies (NRSs) aimed to evaluate the clinical efficacy and safety of two types of surgical interventions (respectively drainage alone and drainage with primary fistula treatment) for perianal abscesses (PAs) in children. Materials and Methods Studies from 1992 to July 2022 were searched in 10 electronic databases. All relevant NRSs with available data which compared surgical drainage with or without primary fistula treatment were included. Patients with underlying diseases which led to abscess formation were excluded. The Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias and quality of the included studies. The outcomes were the healing rate, fistula formation rate, fecal incontinence, and wound healing duration. Results A total of 16 articles with 1,262 patients were considered suitable for the final meta-analysis. Primary fistula treatment was associated with a significantly higher healing rate when compared with incision and drainage alone (OR 5.76, 95% CI 4.04-8.22). This aggressive procedure for PA resulted in an 86% reduction in the fistula formation rate (OR 0.14, 95% CI 0.06-0.32). Limited data showed patients who underwent primary fistula treatment have a minor effect on postoperative fecal incontinence. Conclusion Primary fistula treatment demonstrates a better clinical efficacy in promoting the healing rate and decreasing the formation of fistulas in PAs in children. The available evidence for a minor impact on anal function after this intervention is less strong.

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

A Systematic Review and Meta-Analysis of Comparing Drainage Alone versus Drainage with Primary Fistula Treatment for the Perianal Abscess in Children

et al. 2023

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“…Ultrasound can help detect fistula‐in‐ano and perianal abscess to inform surgical interventions such as drainage or incision; accordingly, it is useful as a supplement to physical examination for the diagnosis and management of patients with perianal inflammation 1,25 …”

Section: Discussionmentioning

confidence: 99%

“…Therefore, it is important to consider factors related to abscess formation. Perianal abscess and fistula‐in‐ano can occur in infants without underlying disease; 1,25 therefore, related symptoms in infants who cannot express complaints may be difficult to detect and the lesions may progress. Contrastingly, older patients can express related symptoms more easily than infants.…”

Section: Discussionmentioning

confidence: 99%

Incidence and diagnostic performance of ultrasound for perianal abscess or fistula‐in‐ano in pediatric patients with perianal inflammation

Hosokawa

Tanami

Sato

et al. 2023

J of Clinical Ultrasound

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Objectives: To describe the incidence and diagnostic performance of ultrasound for perianal abscess or fistula-in-ano in pediatric patients with perianal inflammation. Methods:We included 45 patients with perianal inflammation who underwent ultrasonography. To demonstrate the diagnostic performance of ultrasound for fistula-in-ano, a definite diagnosis of perianal abscess, and fistula-in-ano was determined as that proven through magnetic resonance imaging (MRI) or computed tomography (CT). The absence or presence of perianal abscess and fistula-in-ano on ultrasonography was recorded.Results: Among the 45 patients, on ultrasound, perianal abscess and fistula-in-ano were detected in 22 (48.9%) and 30 (68.2%) patients, respectively. Nine patients had MRI or CT and a definite diagnosis of perianal abscess or fistula-in-ano; accuracy, negative predictive value, and positive predictive value of ultrasound for perianal abscess were 77.8%

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“…General anesthesia, local anesthesia, and regional anesthesia techniques have traditionally been used in anesthesia management of patients undergoing perianal surgery [6,7]. General anesthesia has been reported to prolong hospital stay and patient discharge as a consequence of postoperative nausea and vomiting and postoperative pain compared to local and regional anesthesia [8,9]. On the other hand, perianal surgery with local anesthetic infiltration requires concomitant sedation which can reduce patient comfort [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Comparison of spinal versus caudal epidural anesthesia in the management of patients undergoing ambulatory perianal surgery: Randomized, prospective study

et al. 2021

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Management of perianal abscesses in infants without general anaesthesia: a systematic review of the literature

Cited by 11 publications

References 27 publications

A Systematic Review and Meta-Analysis of Comparing Drainage Alone versus Drainage with Primary Fistula Treatment for the Perianal Abscess in Children

A Systematic Review and Meta-Analysis of Comparing Drainage Alone versus Drainage with Primary Fistula Treatment for the Perianal Abscess in Children

Incidence and diagnostic performance of ultrasound for perianal abscess or fistula‐in‐ano in pediatric patients with perianal inflammation

Comparison of spinal versus caudal epidural anesthesia in the management of patients undergoing ambulatory perianal surgery: Randomized, prospective study

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