Objective To study the clinical effect of one-time radical operation on perianal abscess in children. Methods Seventy-five children with perianal abscess diagnosed and treated from January 2019 to December 2022 were selected and divided into a radical group （n=38） and a conservative group （n=37） according to random number table method. The conservative group was treated with conservative treatment, and the radical group was treated with one-time radical operation. The therapeutic effective rate, perianal function, complications, and other data were collected and analyzed. Results There was no significant difference in the therapeutic effective rate between the two groups （P>0.05）. There was no significant difference in perianal function scores before treatment, and after different treatments, the perianal function scores decreased in both groups, with no statistical difference between the two groups （P>0.05）. The complication incidence rate in the conservative group was lower than that in the radical group （P<0.05）. Conclusion In the treatment of children with perianal abscess, one-time radical surgery has the same effect as conservative treatment, but the risk of complications caused by conservative treatment is lower, so the conservative treatment is recommended to use in clinical treatment.