Management of Perianal Abscesses in Infants: A Systematic Review From the APSA Outcomes and Evidence-Based Practice Committee.
Document Type
Article
Publication Date
12-2025
Identifier
DOI: 10.1016/j.jpedsurg.2025.162691
Abstract
BACKGROUND: Management of infant perianal disease, including perianal abscess and fistula-in- ano (FIA), remains controversial. There is lack of consensus regarding the risks and benefits of operative and non-operative approaches.
METHODS: The American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee created a priori consensus-based questions regarding the various approaches to management of perianal abscess and FIA in infants. A comprehensive search strategy was created, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to identify and review relevant articles and answer the established questions.
RESULTS: Over 2460 titles and abstracts were screened to identify 31 manuscripts describing the expected course of perianal disease when managed with nonoperative management (NOM) strategies (such as hygiene, sitz baths, and systemic antibiotics), operative intervention for abscess only (incision and drainage (I&D)) or direct surgical management of the FIA (e.g. upfront fistulotomy). Initial failure of NOM is approximately 37.5 %. Recurrence rate after initial success with NOM or I&D is approximately 21 % and 24 %, respectively. The rate of FIA development is approximately 21 % after NOM and 20 % after I&D. Recurrence after operative management of FIA, regardless of approach, is 7 %. Time to complete resolution varies widely and does not appear to differ based on treatment strategy.
CONCLUSIONS: Both operative and non-operative approaches can be safely used in the management of perianal abscess and FIA but recurrence is common regardless of approach. Risks and benefits of each approach should be considered on a case-by-case basis.
TYPE OF STUDY: Systematic Review of level 3-4 studies.
LEVEL OF EVIDENCE: Level 4.
Journal Title
Journal of pediatric surgery
Volume
60
Issue
12
First Page
162691
Last Page
162691
MeSH Keywords
Humans; Abscess; Anus Diseases; Infant; Drainage; Rectal Fistula; Anti-Bacterial Agents; Recurrence; Evidence-Based Medicine
PubMed ID
40983150
Keywords
Fistula-in-ano; Fistulotomy; Infants; Perianal abscess; Perirectal abscess
Recommended Citation
Acker SN, Sulkowski J, Chang HL, et al. Management of Perianal Abscesses in Infants: A Systematic Review From the APSA Outcomes and Evidence-Based Practice Committee. J Pediatr Surg. 2025;60(12):162691. doi:10.1016/j.jpedsurg.2025.162691
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