Comparison of different treatment modalities for perianal abscess in infants: a retrospective cohort study

The optimal management of perianal abscess ( PA) in infants remains controversial. This study aimed to compare incision and drainage (ID), incision and drainage with primary fistulotomy (IDF), and conservative management(CM)for the treatment of infants with PA (< 1 year). A retrospective cohort study was conducted for infants with PA between 2014 and 2020. Patients undergoing IDF were assigned to the IDF group, those undergoing ID were assigned to the ID group, and those whose parents declined surgery were assigned to the CM group. A total of 597 patients were identified (591 boys and 6 girls); 282 in the IDF group, 162 in the ID group, and 153 in the CM group. The median age at first visit was 43 days (range 30-90 days). The median follow-up was 5.8 years (range 3-9.4 years). The baseline characteristics of the three groups were similar (except for abscess size, length of stay, and inpatient costs). The cure rate in the IDF group (97.8%, 276/282) was higher than that in the ID group (82.1%, 133/162; p < 0.001), and the CM group (80.4%, 123/153; p < 0.001). No severe complications were found in the ID or CM groups. The IDF group had 3 cases of sepsis, including 1 with a concurrent central nervous system infection. No fecal incontinence was observed in any of the patients. PA in infants may be a self-limiting disease. CM should be the first-line approach in most cases of PA in infants.