Journal article
Management of Perianal Abscesses in Infants: A Systematic Review From the APSA Outcomes and Evidence-Based Practice Committee
Journal of pediatric surgery, v 60(12), p162691
01 Dec 2025
PMID: 40983150
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Abstract
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.
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.
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.
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.
Systematic Review of level 3-4 studies.
Level 4.
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Details
- Title
- Management of Perianal Abscesses in Infants: A Systematic Review From the APSA Outcomes and Evidence-Based Practice Committee
- Creators
- Shannon N. Acker - University of Colorado DenverJason Sulkowski - Children's Hospital of Richmond at VCUHenry L. Chang - Johns Hopkins All Children's HospitalJohn Cyrus - Virginia Commonwealth UniversityEmily Christison-Lagay - Yale New Haven HospitalSara A. Mansfield - Nationwide Children's HospitalDiana L. Diesen - The University of Texas Southwestern Medical CenterBrian C. Gulack - Rush University Medical CenterKatie Russell - University of UtahAlana L. Beres - Drexel University, SurgeryRebecca M. Rentea - Children's Mercy HospitalYasmine Yousef - Joe DiMaggio Children's HospitalHanna Alemayehu - Emory UniversityMelissa E. Danko - Children's Healthcare of AtlantaSandra K. Kabagambe - University of VirginiaAfif N. Kulaylat - Penn State Milton S. Hershey Medical CenterTamar L. Levene - Joe DiMaggio Children's HospitalChristopher Pennell - Drexel University, PediatricsStephanie F. Polites - Mayo Clinic in ArizonaJoshua K. Ramjist - University of TorontoBarrie S. Rich - Cohen Children's Medical CenterStefan Scholz - Children's Hospital of PittsburghDavid E. Skarda - University of UtahJun Tashiro - NYU Langone HealthMatthew T. Hey - Brigham and Women's HospitalRomeo Ignacio - Division of Pediatric Surgery, Dept of General Surgery, UCSD School of Medicine, USARobert Baird - McGill UniversityLorraine I. Kelley-Quon - University of Southern CaliforniaRob Ricca - Pennsylvania State Universitythe American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee
- Publication Details
- Journal of pediatric surgery, v 60(12), p162691
- Publisher
- Elsevier Inc
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Pediatrics; Surgery
- Web of Science ID
- WOS:001589235400002
- Scopus ID
- 2-s2.0-105017279245
- Other Identifier
- 991022116083804721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Pediatrics
- Surgery