Perianal abscesses (PA) are common infections affecting infants, traditionally treated through surgical means, but recent findings suggest conservative management could be as effective and less invasive.
A large-scale study involving 597 infants aimed to compare three treatment strategies for PA: incision and drainage (ID), incision and drainage with primary fistulotomy (IDF), and conservative management (CM). The retrospective cohort study conducted at the Affiliated Hospital of Jining Medical University examined data from infants treated between 2014 and 2020.
The researchers discovered significant differences between the treatment methods. While the IDF group showed the highest cure rate at 97.8%, those treated with ID had 82.1%, and the CM group reported 80.4%. Despite the surgical methods proving more effective, findings suggest CM should be considered a first-line treatment option due to its effectiveness and lower risk of complications.
Historically, PA has been considered surgical territory due to its potential complications and treatment failures. The study assessed 772 infants initially diagnosed with PA, narrowing down to 597 eligible participants who met the criteria based on various factors including the nature of their abscess. The findings challenge the conventional reliance on surgery, offering new perspectives on managing this common infant condition.
The study's results indicate a trend toward seeing PA as self-limiting under certain conditions. While surgical interventions have their place, CM poses as an effective alternative when parents opt against surgery, achieving respectable long-term cure rates.
Dr. Wang and co-authors emphasized: "CM should be the first-line approach in most cases of PA in infants," highlighting the effectiveness of non-invasive strategies. They propose extending CM where feasible, to alleviate the trauma associated with surgery and general anesthesia.
The research adds to accumulated evidence of the effectiveness of conservative methods, citing the historical perception of PA as solely surgical, reflecting on its potential for resolution without invasive procedures.
Along with treatment failure rates, the study reported no instances of fecal incontinence among patients, emphasizing the safety of both surgical and conservative management options. Increasingly, data suggests many infants recover through CM alone.
This investigation reflects broader shifts within pediatric healthcare, advocating for surgical restraint and prioritization of conservative options. Future research will explore CM's effectiveness more deeply, promising to reshape the treatment paradigm for perianal abscesses.
It is with this awareness of both efficacy and safety concerns, coupled with the historical data on infant PA treatment, the authors conclude with significant recommendations for pediatricians dealing with early presentations of this common ailment.