The outcomes of surgical incision of perianal abscess under local anesthesia in neonates less than one month of age

Background: Perianal abscess (PA) is a relatively common condition acquired in infancy, yet its treatment method remains controversial. We reviewed the outcome of neonates with PA who were treated with surgical incision under local anesthesia (LA). Objective: To show the outcome of surgical incision under LA in most neonates with PA and compare it with using antibiotic alone for decreasing incidence of fistula in ano and no need for incision under general anesthesia. Patients and Methods: This study involved 48 neonates with PA. In period from April 2016 to December 2017, in outpatient clinic Some of them had undergone incision under LA, while the others, their parents refused surgical incision and were given broad spectrum antibiotics. All of them were followed up for one year to screen for anal fistula. Results: Out of the 48 neonates, 36 (75%) were males and 12(25%) were females. There were 30 (62.5%) neonates with PA on right side, 16( 33.5%) on left side and only two patients ( 4%) had PA on both sides. The pus of all those neonates were sent for culture and sensitivity and the growth revealed staphylococcus aureus in 72%, E-Coli in 14%, mixed growth in 7% while only 7% developed no growth. Out of the 48 neonates, 28 (51.6 %) had undergone surgical incision under LA (3.5% of them developed perianal fistula) and 20 neonates (48.4%) were given broad spectrum antibiotics (75% of them developed perianal fistula). Conclusion: Surgical incision under LA is more effective in most neonates with PA. It appears prudent to manage these patients with surgical incision under LA while broad spectrum antibiotic alone may increase the incidence of perianal fistula.