Efficacy of conservative treatment of perianal abscesses in children and predictors for therapeutic failure
Background The optimal management of perianal abscess in children is controversial. Purpose To evaluate the efficiency of conservative treatment of perianal abscess in children and identify parameters that predict therapy failure. Methods All cases of children younger than 14 years of age with peria...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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The Korean Pediatric Society
2020-07-01
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| Series: | Clinical and Experimental Pediatrics |
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| Online Access: | http://www.e-cep.org/upload/pdf/cep-2019-00969.pdf |
| _version_ | 1818383779782197248 |
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| author | Lars Boenicke Johannes Doerner Stefan Wirth Hubert Zirngibl Mike Ralf Langenbach |
| author_facet | Lars Boenicke Johannes Doerner Stefan Wirth Hubert Zirngibl Mike Ralf Langenbach |
| author_sort | Lars Boenicke |
| collection | DOAJ |
| description | Background The optimal management of perianal abscess in children is controversial. Purpose To evaluate the efficiency of conservative treatment of perianal abscess in children and identify parameters that predict therapy failure. Methods All cases of children younger than 14 years of age with perianal abscesses between 2001–2016 were evaluated. Results Of the 113 enrolled patients, 64 underwent subsequent surgery for advanced disease (primary surgery group). Conservative treatment was initiated in 49 patients (primary conservative group) but was stopped because of inefficiency in 25 patients, who were referred for surgery after a median 7.03 days (range, 2 to 16 days). The other 24 patients (48%) initially achieved complete remission after conservative treatment, but 10 were readmitted after a median 34 months (range, 3 to 145 months) with recurrent disease. There were no significant differences in permanent success after conservative treatment between infants (10 of 29, 34%) and older children (4 of 20 [20%], P=0.122). Overall, conservative treatment alone was effective in only 14 of 113 patients. Recurrence after surgery occurred in 16 patients (25%) in the primary surgery group and 11 patients (22%) in the primary conservative group (P=0.75). Univariate analysis of predictors for conservative treatment failure revealed inflammatory values (C-reactive protein and white blood count, P=0.017) and abscess size (P=0.001) as significant parameters, whereas multivariate analysis demonstrated that only abscess size (odds ratio, 3.37; P=0.023) was significant. Conclusion Conservative treatment of perianal abscess is permanently efficient in only a minority of children but is not associated with a higher recurrence rate after subsequent surgery. Abscess size is a predictor for therapy failure. |
| first_indexed | 2024-12-14T03:11:48Z |
| format | Article |
| id | doaj.art-3d57b8ed5d0c47b7a795f4f15ba609bd |
| institution | Directory Open Access Journal |
| issn | 2713-4148 |
| language | English |
| last_indexed | 2024-12-14T03:11:48Z |
| publishDate | 2020-07-01 |
| publisher | The Korean Pediatric Society |
| record_format | Article |
| series | Clinical and Experimental Pediatrics |
| spelling | doaj.art-3d57b8ed5d0c47b7a795f4f15ba609bd2022-12-21T23:19:15ZengThe Korean Pediatric SocietyClinical and Experimental Pediatrics2713-41482020-07-0163727227710.3345/cep.2019.0096920125553650Efficacy of conservative treatment of perianal abscesses in children and predictors for therapeutic failureLars Boenicke0Johannes Doerner1Stefan Wirth2Hubert Zirngibl3Mike Ralf Langenbach4 Department of General and Visceral Surgery, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany Department of General and Visceral Surgery, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany Department of Pediatrics, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany Department of General and Visceral Surgery, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany Department of General and Visceral Surgery, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, GermanyBackground The optimal management of perianal abscess in children is controversial. Purpose To evaluate the efficiency of conservative treatment of perianal abscess in children and identify parameters that predict therapy failure. Methods All cases of children younger than 14 years of age with perianal abscesses between 2001–2016 were evaluated. Results Of the 113 enrolled patients, 64 underwent subsequent surgery for advanced disease (primary surgery group). Conservative treatment was initiated in 49 patients (primary conservative group) but was stopped because of inefficiency in 25 patients, who were referred for surgery after a median 7.03 days (range, 2 to 16 days). The other 24 patients (48%) initially achieved complete remission after conservative treatment, but 10 were readmitted after a median 34 months (range, 3 to 145 months) with recurrent disease. There were no significant differences in permanent success after conservative treatment between infants (10 of 29, 34%) and older children (4 of 20 [20%], P=0.122). Overall, conservative treatment alone was effective in only 14 of 113 patients. Recurrence after surgery occurred in 16 patients (25%) in the primary surgery group and 11 patients (22%) in the primary conservative group (P=0.75). Univariate analysis of predictors for conservative treatment failure revealed inflammatory values (C-reactive protein and white blood count, P=0.017) and abscess size (P=0.001) as significant parameters, whereas multivariate analysis demonstrated that only abscess size (odds ratio, 3.37; P=0.023) was significant. Conclusion Conservative treatment of perianal abscess is permanently efficient in only a minority of children but is not associated with a higher recurrence rate after subsequent surgery. Abscess size is a predictor for therapy failure.http://www.e-cep.org/upload/pdf/cep-2019-00969.pdfanal fistulaconservative treatmentchildperianal abscessrecurrence |
| spellingShingle | Lars Boenicke Johannes Doerner Stefan Wirth Hubert Zirngibl Mike Ralf Langenbach Efficacy of conservative treatment of perianal abscesses in children and predictors for therapeutic failure Clinical and Experimental Pediatrics anal fistula conservative treatment child perianal abscess recurrence |
| title | Efficacy of conservative treatment of perianal abscesses in children and predictors for therapeutic failure |
| title_full | Efficacy of conservative treatment of perianal abscesses in children and predictors for therapeutic failure |
| title_fullStr | Efficacy of conservative treatment of perianal abscesses in children and predictors for therapeutic failure |
| title_full_unstemmed | Efficacy of conservative treatment of perianal abscesses in children and predictors for therapeutic failure |
| title_short | Efficacy of conservative treatment of perianal abscesses in children and predictors for therapeutic failure |
| title_sort | efficacy of conservative treatment of perianal abscesses in children and predictors for therapeutic failure |
| topic | anal fistula conservative treatment child perianal abscess recurrence |
| url | http://www.e-cep.org/upload/pdf/cep-2019-00969.pdf |
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