Medical Student Oakland University William Beaumont School of Medicine TROY, Michigan, United States
Abstract Body : Perianal abscesses are tender masses located at the anal verge, most typically in the 3 o’clock and 9 o’clock positions and develop due to infection in abnormally deep crypts of Morgagni. While surgical treatment is commonly employed, within the past decade, there has been increased support for non-operative management of perianal abscesses. This study aimed to compare the effectiveness of a non-operative protocol to the traditional method of incision and drainage (I&D) for management of infant perianal abscesses.
Patients treated at Beaumont Children’s under the age of 12 months identified as having a perianal abscess less than 2cm from the anal verge and less than 3cm in size were included. Subjects who were immunocompromised, had anorectal malformation, or a history of Hirschsprung’s were excluded. Patients were treated using either the protocol or surgical approach based on surgeon preference. The protocol involves Sitz baths and warm compresses three times a day and no antibiotics. Phone call follow-ups were performed three months after initial evaluation to determine outcomes. De-identified data were collected from the patient’s EMR, including time to resolution, recurrence rates, and need for surgical intervention. Fisher’s Exact Test was used to compare time to resolution and recurrence rates for the two groups.
Thirteen patients under the age of one were enrolled in the study – 6 in the non-operative protocol and 7 received I&D of their abscesses. The traditional I&D group had a lower recurrence rate when compared to the non-operative protocol group 0% vs 33% (p = 0.02). No difference was seen between the groups with respect to time to resolution. All children in the non-operative protocol and traditional I&D groups had resolution of their symptoms by the three month follow up.
The initial findings suggest surgical management of perianal abscesses is more definitive than Sitz water baths. Surgical management showed fewer recurrences of perianal abscess after initial evaluation with a similar time to resolution as Sitz baths. While 1/3 of the non-operative protocol group needed I&D after initial surgical evaluation, 2/3 were able to be successfully managed without I&D.
Surgical management is still considered to be the standard of care in managing perianal abscesses. While the data demonstrates that surgical management is associated with decrease in abscess recurrence in comparison to Sitz baths both methods of treatment are effective at 3 months follow up. Currently, the data set is too small to definitively suggest protocol management is more effective in treating perianal abscesses than surgical intervention. Future directions include increasing the sample size to include at least 40 patients would be beneficial to better assess efficacy between the two groups.
