%J Journal of Pediatric Surgery
%N 3
%C United States
%L discovery10204879
%V 60
%K Fistula-in-ano, Infant, Paediatric surgery, Perianal abscess
%T Non-operative Versus Operative Management of Perianal Abscess in Infants: A 10-year Retrospective Study at Two Centres in the United Kingdom
%D 2025
%O This version is the author-accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
%X Background:
Perianal abscess (PA), with or without fistula-in-ano (FIA) is common in infants. Treatment options include incision and drainage under general anaesthesia or non-operative treatments, such as antibiotics and/or aspiration under local anaesthetic, which avoid the risks of surgery. Current management is based on surgeon preference due to a poor underlying evidence base. In this study we aimed to compare outcomes for non-operative and operative management of infant PA.//

Methods:
10-year retrospective review (2012–2022) of infants aged ≤12 months presenting with PA to two paediatric surgery centres in the United Kingdom. Clinical features, management and outcome data were extracted from electronic records.//
Results:
116 infants were identified; 113/116 (97 %) were male. Median age at presentation was 2 (IQR 1–6) months. Initial management was non-operative in 73/116 (63 %) and operative in 43/80 (37 %). Median follow-up was 3 (IQR 2–6) months. Recurrence occurred in 49/116 (42 %) at a median time of 1 (IQR 0–3) month and was significantly higher in the non-operative compared to the operative group (39/73 [53 %] versus 10/43 [23 %], p = 0.001). Operative management was independently associated with a reduced risk of PA recurrence (OR 0.25 [95 % confidence interval 0.09–0.68], p = 0.007). Further surgery was performed in 26/73 (36 %) in the non-operative group and 7/43 (16 %) in the operative group (p = 0.026). Subsequent FIA rates were not significantly different (23/73 [32 %] versus 8/43 [19 %], p = 0.129).//
Conclusions:
In this study, PA recurrence and the requirement for further operative intervention were significantly higher when a PA was initially managed non-operatively, although subsequent FIA rates were similar.
%A JJ Neville
%A K Humpleby
%A C Healy
%A NJ Hall
%A MP Stanton
%I Elsevier BV