In pediatric surgery clinics, perianal abscesses are not uncommon, and many parents run to the hospital every day for this reason, queuing, registering, changing medication, so that the wound grows well, and after a while the abscess recurs, and then once again cut and drainage, queuing, registering, changing medication, and so on, repeated several times, delayed for months, and after a while the doctor also said that the formation of anal fistula, to do surgery, which is really frantic. As the name implies, a perianal abscess is an abscess that grows around the anus and is a cavity formed after bacterial infection and necrosis and liquefaction of the perianal tissue. Like other infected lesions, perianal abscesses are mainly red, swollen and painful, but children are too young to tell, the location of the abscess is hidden, and most abscesses are relatively small and rarely cause systemic symptoms such as fever, so they are not easily detected by parents, and are often noticed only when the child cries while defecating or sitting. The causes of perianal abscesses are still unclear. The above mentioned pathogenic factors cannot be changed by human beings, so there is no good way to prevent them, but clinically, we find that many children develop the disease after diarrhea, so it is not excluded that the anal canal is stimulated by stool pollution. The skin of small babies is very delicate, so to avoid frictional damage that could trigger infection, use soft, non-irritating wipes when wiping the anus. The size of perianal abscesses varies, from small ones the size of a grain of rice, which may break down and heal on their own without realizing it, to large ones the size of a walnut, which may even lead to redness and swelling of the entire buttocks and require hospitalization. 90% of perianal abscesses are in one or two places, and if we consider the anus as a clock, abscesses mainly occur at the 3 and 9 o’clock positions, accounting for about 70% of the cases. It is because of the small size of this disease that it has not been studied deeply enough, and like the pathogenesis is not clear, there is some controversy about its treatment. According to the principle of surgical treatment, as long as the surface of the abscess is white, the pus can be seen, and the pus cavity is soft and volatile to the touch, it should be cut and drained to drain out the pus in order to heal quickly. However, perianal abscesses do have a high recurrence rate after incision and drainage (about 1/3), and many also form anal fistulas (about 1/5 to 1/3), which means that a chronic inflammatory fistula forms between the external opening of the pus cavity and the anal canal. However, in 2007, the American Journal of Pediatrics published an article arguing that perianal abscesses up to 1 year of age are different in nature from perianal abscesses at other ages. Based on case summaries from two medical centers, it was found that perianal abscesses within 1 year of age treated with only perianal care and anti-infection therapy had a much lower rate of later anal fistula than children who had incision and drainage, and an even lower rate of anal fistula in children who had antibiotics added. This conclusion broke with common sense, so it was quickly disputed that this was a retrospective study, not a randomized group, and that the size of the abscesses was not recorded, so perhaps the physicians treated the larger abscesses with incision and drainage and the smaller abscesses with conservative treatment, and that the abscesses were naturally different in size and had different rates of complicating anal fistula. It is also true that most studies have concluded differently from that one, for example, another article in the International Journal of Pediatric Surgery in 2011 concluded that there was no statistical difference in the recurrence rate and the incidence of anal fistula between the two methods of incision and drainage and conservative treatment, and that the incidence of the former was lower. As for the need for antibiotics, many studies have come to different conclusions, with some saying that antibiotics reduce the probability of recurrence and anal fistula formation, but others concluding that the use of antibiotics does not reduce the incidence of anal fistula. Overall, the role of antibiotics in the treatment of perianal abscesses, cut or uncut, is controversial. In clinical practice, for relatively small abscesses with incomplete liquefaction, most doctors also take conservative treatment, including perianal cleaning care, and also sitz baths with potassium permanganate solution after stool, and some doctors also recommend oral antibiotics, and some of them heal slowly. However, for abscesses that slowly increase in size and liquefaction is obvious, such as seeing pus and feeling fluctuating, most doctors will also recommend incision and drainage, leaving aside problems such as recurrence and anal fistula, although incision is somewhat painful for the child, the pus is released after incision, which can also relieve local inflammatory stimulation and reduce the child’s pain. For patients who are younger and have systemic symptoms like fever, many are admitted to the hospital for treatment. Because of the location near the anus, the wound can easily be contaminated by feces, so it is also important to strengthen the care of the wound after incision, to clean it in time and to keep it dry. For the formation of anal fistula, there is not no chance of self-healing, some articles say that the self-healing rate is about 1/6, but on average it takes more than 5 months, and if it does not heal for a long time, the fistula will be opened (including hanging wires) or fistula removal surgery. The good news is that most fistulas in children are simple and not as complicated as those in adults, so the prognosis is better and basically does not affect anal function. Treatment of perianal abscesses in children older than 2 years of age is similar to that of adult perianal abscesses, with incision and drainage being the mainstay, but one needs to be alert to the possibility of secondary immune diseases.