In Reply.—

Several operations routinely performed in the recent past have become nearly obsolete, appropriately supplanted by medical management. For example, the trauma splenectomy, exploration for traumatic liver hemorrhage, and laparotomy for perforated appendicitis have been relegated to the annals of surgical management not because of results of randomized trials but because of advances in nonoperative paradigms and careful review of outcomes data over the last 2 decades.

We reported that nonoperative management of uncomplicated perianal abscesses in otherwise healthy infants also results in better outcomes. The purpose of our article was not to define the cause of perianal abscesses in infants, which is likely to be multifactorial, but to call attention to the observed difference in outcome between infants managed by drainage as opposed to those managed nonoperatively, because the operative approach yielded a statistically significant progression to fistula in ano. Although the size of the abscess was...

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