Comparison of Outcomes in Pediatric Perianal Abscess Under General Anesthesia Versus Local Anesthesia

Abstract

Background: Perianal abscess (PA) is a common surgical condition in infants, with ongoing debate regarding the optimal anesthesia approach for drainage — general anesthesia (GA) or local anesthesia (LA). Objectives: The present study compares recurrence rates and clinical outcomes between GA and LA in pediatric PA patients. Methods: A retrospective cohort study analyzed 426 medical records of children under 2 years of age treated for PA between 2012 and 2022 at a tertiary center in Iran. Patients were stratified into the LA (n = 365) and GA (n = 61) groups based on clinical assessment. Data included demographics, abscess characteristics, recurrence rates, and complications. Statistical analysis was performed using t-tests and chi-square tests. Results: The cohort demonstrated significant male predominance (85.2%) with a mean age of 1.99 months. Local anesthesia was associated with a significantly lower recurrence rate compared to GA (23.3% vs. 32.8%, P < 0.05), despite the GA group having larger abscesses (8.45 mm vs. 7.62 mm, P = 0.001) and older patients. New abscess formation was uncommon (3.8% overall) with no significant difference between groups. The 3 o’clock (23.2%) and 9 o’clock (16.0%) positions were the most frequent abscess locations. Even after adjusting for age and abscess size in multivariable analysis, LA was associated with reduced recurrence risk. Conclusions: Local anesthesia demonstrates favorable outcomes for uncomplicated perianal abscesses (PAs) in infants, showing lower recurrence rates compared to GA. General anesthesia remains preferred for complex cases characterized by larger abscess size or other complicating factors. These findings support individualized anesthesia selection based on abscess characteristics and patient factors, with LA serving as a first-line approach for suitable cases.