A Retrospective Study On The Safety And Effectiveness Of Conservative Treatment Of Perianal Abscess In Infants

ObjectivePerianal abscess is a common anorectal disease in infants,but the optimal treatment of which is still a controversy.Outpatient abscess incision is applied extensively as a traditional treatment method,but a part of children still have not got well after regular debridement and dressing changes in the clinic,and even evolved into anal fistula,which not only increases the sufferings of children but also brings heavy psychological burden to family members of children.In recent years,some scholars have proposed that conservative treatment be likely to become a more secure and effective treatment compared to incision and drainage(ID),but fewer related research cases result in lacking further data support.The retrospective study aims at further exploring the safety and effectiveness of conservative treatment for the first onset of perianal abscess in infants less than 1 year of age.Meanwhile,the correlation between the incidence of infant perianal abscess,treatment options,recurrence or evolution into anal fistula probability and age will be investigated.MethodsThe clinical case-control study is adopted.The data were derived from the medical records and information of telephone follow-up of infants diagnosed with perianal abscess in the Pediatric Surgery Clinic from January 2018 to December 2018 in Dalian childrens Hospital.The children included in the study were divided into groups in accordance with the age of the infants to compare the relation between the incidence of perianal abscesses,the choice of treatment,and the probability of recurrence or evolution into anal fistula and the age of the children.The prognosis of the two treatments including conservative treatment and incision and drainage(ID)was contrasted according to the different treatment methods.The criteria for evaluating the prognosis of the two treatments consist of two aspects: Firstly,duration of the disease(some cases of children who have not recurred or evolved into anal fistula during the follow-up period);Secondly,whether children relapse or evolve into anal fistula or not.Such relative information as the child's gender,age(?1 year),treatment,relapse status(including whether she or he evolves into anal fistula),status of children followed byfever and other systemic symptoms,the levels of tolerable pain,and application conditions of oral or intravenous antibiotics are recorded and analyzed through statistics.ResultsA total of 90 children were enrolled in the study who were male.The median duration at the onset of illness in the hospital was 8 days(range: 2,28),the median children age of onset was 75 days(range: 15,365),and the median follow-up time of cases in the study was 351 days(range: 270,395).1.To compare the correlation between the incidence of the disease,treatment options,probability of recurrence or progression to anal fistula and the age of onset of children.:According to age to group the cases,the number of cases at the age of 0-3months old was 51(56.7%);the number of cases at the age of 4-6 months was 17(18.9%);the number of cases at the age of 7-9 months was 12(13.3%);the number of cases at the age of 10-12 months was 10(11.1%).It can be found that the incidence of children at 0-3 months of age reach the peak in the study,and then show a gradual downward trend.Based on the age of children,all cases were divided into two groups including the 0-3 month and the 4-12 month to make a contrast for a second time,It was demonstrated that there was no significant difference in the proportion of conservative treatment and incision drainage(ID)in the two groups at the level of statistics(P = 0.288),neither was the probability of recurrence or progression to anal fistula between the two groups(P = 0.824).The doctor's choice of treatment methods did not present evident relevance to the age of onset of the child on the study,neither did the probability of recurrence or progression to anal fistula.2.Different treatment methods and prognosis : According to different treatment methods,children were divided into conservative treatment and incision drainage group.The number of children treated with conservative treatment was 42(46.7%),and the number of children treated with incision drainage(ID)was 48(53.3%).A total of 9(21.4%)children had recurred or progressed to anal fistula during diagnosis or prognosis in the conservative treatment group,which was lower in proportion to incision drainage(ID)(41.7% 20/48 P = 0.045).When comparing the course length of the two groups,the data of cases about recurrence or progression to anal fistula were excluded,it can be summarized that the median course length of the children in the conservative treatment group was 31 days(range: 3,55),and that in the incision anddrainage group was 24 days(range: 7,50).The conclusion was drawn that there was no statistically significant differences in the length of the disease of the children between two different treatments(P = 0.166).ConclusionIt can be showed that conservative treatment of perianal abscess in infants can significantly reduce the probability of recurrence or progression to anal fistula in contrast to incision and drainage(ID).Although the cases of children who relapsed or progressed to anal fistula during the follow-up period were excluded,the length of the two treatments has no significant differences,the family members of the children can follow the doctor's advice and complete the process of conservative treatment at home to avoid repeated dressing changes in the outpatient because of the incision,which also lessens the pain of the children and the financial burden of the family and save much time.In a word,it is proved that conservative treatment is a safe and effective method for infant perianal abscess.