Treatment of perianal abscess in children: spontaneous drainage or incision-drainage?

Abstract

Background: The aim of the study is to evaluate the clinical characteristics and compare the treatment methods for perianal abscesses by assessing our treatment experiences. Methods: We have retrospectively analyzed the records of the children who received perianal abscess and fistula-in-ano treatment between January 2014 and January 2022. Demographic information of the patients, complaints, treatment procedures, abscess recurrence, and development of fistula-in-ano was evaluated. Patients with systemic diseases and inflammatory bowel diseases were excluded from the study. Results: A total of 312 children (230 boys, 82 girls) were included in the study. The median age was 24.3 ± 18.1 months (1–216). In the first examination, 61 (19.5%) patients had fistula-in-ano and 25 1(80.5%) patients had a perianal abscess. The most common symptoms were erythema in the perianal region, mass, constipation, rectal bleeding, and inability to defecate. Spontaneous drainage was determined in 34.3% (n = 86) of the perianal abscess, and 65.7% (n = 165) of perianal abscesses were treated with incision-drainage without general anesthesia and systemic antibiotherapy. In the follow-up, fistula-in-ano formed in 27 patients who had a perianal abscess. Twenty-four of the patients who developed fistula-in-ano, were seen after spontaneous drainage, and 3 of them were seen after incision drainage. Perianal abscess recurred in 64 patients. Spontaneously drained abscess significantly increased the development of fistula-in-ano (p = 0.001). However, recurrences in a perianal abscess (25.4%) do not increase the fistula-in-ano formation (p > 0.05). In fistula-in-ano treatment, 10 (11.5%) patients were resolved spontaneously, 70 (79.5%) patients were treated with fistulotomy and 8 (9%) patients were treated with fistulectomy. Conclusion: Treatment of perianal abscess and fistula-in-ano in children is still controversial. According to our results, incision-drainage and antibiotic usage in the treatment of the perianal abscess are the most appropriate treatment to decrease the rate of fistula-in-ano.