Non-operative Versus Operative Management of Perianal Abscess in Infants: A 10-year Retrospective Study at Two Centres in the United Kingdom

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery Pub Date : 2024-12-10 DOI:10.1016/j.jpedsurg.2024.162101

J.J. Neville , K. Humpleby , C. Healy , N.J. Hall , M.P. Stanton

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引用次数: 0

Abstract

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.

查看原文本刊更多论文

婴儿肛周脓肿的非手术与手术治疗：英国两个中心的10年回顾性研究。

背景：肛周脓肿（PA）伴或不伴瘘管（FIA）在婴儿中很常见。治疗方案包括全身麻醉下的切口和引流或非手术治疗，如局部麻醉下的抗生素和/或抽吸，可避免手术风险。目前的治疗是基于外科医生的偏好，因为缺乏潜在的证据基础。在这项研究中，我们的目的是比较非手术治疗和手术治疗的结果。方法：10年（2012-2022）回顾性分析英国两家儿科外科中心的年龄≤12个月的PA患儿。从电子记录中提取临床特征、管理和结局数据。结果：116例患儿被确诊；113/116例（97%）为男性。就诊时的中位年龄为2 （IQR 1-6）个月。73/116例（63%）采用非手术治疗，43/80例（37%）采用手术治疗。中位随访时间为3个月（IQR 2-6）。复发率为49/116(42%)，中位时间为1 （IQR 0-3）个月，非手术组复发率明显高于手术组（39/73[53%]对10/43 [23%]，p = 0.001）。手术管理与PA复发风险降低独立相关（OR为0.25[95%可信区间0.09-0.68],p = 0.007）。非手术组26/73（36%）、手术组7/43（16%）继续行手术治疗（p = 0.026）。随后的FIA发生率无显著差异（23/73[32%]对8/43 [19%]，p = 0.129）。结论：在本研究中，当PA最初采用非手术治疗时，PA的复发率和进一步手术干预的需求明显更高，尽管随后的FIA率相似。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of pediatric surgery 医学-外科

CiteScore

1.10

自引率

12.50%

发文量

569

审稿时长

38 days

期刊介绍： The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.