Predictors of Recurrence in Pediatric Perianal Abscess and Fistula-In-Ano: Insights From a 5-Year Surgical Cohort Study

BACKGROUND Perianal abscess (PA) and fistula-in-ano (FIA) are common in children, particularly infants. Despite their frequency, their pathophysiology, diagnostic accuracy, and optimal treatment remain debated. This study aimed to evaluate recurrence rates after surgical treatment of PA and FIA and identify clinical factors associated with fistula formation, including ultrasound findings, antibiotic therapy, abscess size, and symptom duration in otherwise healthy pediatric patients. MATERIAL AND METHODS We retrospectively reviewed 108 pediatric patients (0-17 years) treated surgically for PA and/or FIA between January 2019 and February 2024 at a tertiary care center. Inclusion criteria were PA diagnosis and incision and drainage as primary management. Data included intraoperative findings, recurrence, antibiotic use, ultrasound results, symptom duration, and abscess size (infants only). RESULTS Intraoperative FIA was identified in 19/108 patients (17.8%). Overall recurrence occurred in 29 patients (26.9%). Recurrence of PA was more frequent in those with initial FIA (36.8%) than without (24.7%) but was not significant (P>0.05). However, FIA recurrence was significantly higher in patients with initial FIA (31.6% vs 10.1%, P=0.024). Among 99 patients undergoing ultrasound, diagnostic accuracy for PA was 100%. Regarding FIA, there were 3 false negatives and 5 false positives; in 67 cases, no definitive conclusion was provided. Antibiotic therapy, abscess size, and symptom duration showed no significant association with recurrence or FIA development. CONCLUSIONS Initial intraoperative detection of FIA significantly predicts future recurrence. Antibiotic use, symptom duration, and abscess size were not predictive. Findings highlight the need for improved diagnostic tools and standardized management protocols in pediatric PA and FIA.