Original ArticleSurgical treatment of perianal abscess and fistula-in-ano in childhood, with emphasis in children older than 2 years☆
Section snippets
Patients and methods
This is a retrospective consecutive case-series analysis. The medical records of children ranging from 0 to 15 years of age presenting with a PA or an FIA over the last decade (January 1, 2001–November 31, 2011), were reviewed. The study received approval from the local institutional ethical committee, but individual patient consent was waived because the data collected initially and during follow-up were part of routine clinical practice.
All children presenting with a PA and treated by
Results
A total of 98 patients (89 boys [91%] and 9 girls [9%]) were operated on for a PA or FIA. Of those, 46 (47%) presented with only a PA, whereas 52 (53%) presented with an FIA. Six patients with FIA were referred in-house and 46 were referred and diagnosed in the outpatient clinic. The median age of all patients was 7 (range, 0-15) years. In the group of patients with PA, there were only 2 infants (mean age, 4.8 months) needing treatment by incision and drainage, whereas the rest of the children
Discussion
Anal sepsis in children ranges from PA to FIA. Most cases are infants younger than 1 year with a clear male sex predominance, demonstrating a congenital predisposition to the disease [3], [5]. However, older children are not excluded. In infants, the disease is most often treated conservatively with a low incidence of recurrence or FIA development. In older children, however, the disease presentation is more akin to that of adults. Our retrospective review focused therefore on evaluating the
Conclusion
Perianal sepsis in children older than 2 years necessitates surgical treatment. In cases of PA, incision and drainage is an easy, fast, and safe therapy with a low recurrence rate. In children with FIA, most are simple presentations without any significant involvement of the sphincter system. Simple fistulotomy is the most common surgical technique used and, when required fistulotomy with seton placement or cryptotomy, more than meet the needs for surgical treatment.
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Cited by (26)
The Optimal Primary Treatment for Pediatric Perianal Abscess and Anal Fistula: A Systemic Review and Meta-Analysis
2023, Journal of Pediatric SurgeryBenign anorectal disease in children: What do we know?
2022, Archives de PediatrieCitation Excerpt :Αlthough conservative treatment should be the first therapeutic option, surgical techniques must be utilized in more complicated cases with no signs of spontaneous perforation, high likelihood of spreading, or when our initial approach has failed [45, 46]. Over time, many studies support the nonoperative treatment of small, early-stage PAs and fistulas including local hygiene, sitz baths, and spray form of basic fibroblast factor with or without the addition of antibiotics or local therapy by needle aspiration, with high success rates of spontaneous resolution [37, 38, 45–48]. For refractory PA, incision and drainage is considered the optimal intervention, abbreviating healing period, decreasing the patient's discomfort, and lowering the probability of fistula formation [36, 49].
A SYSTEMATIC REVIEW AND META-ANALYSIS OF COMPARING DRAINAGE ALONE VSDRAINAGE WITH PRIMARY FISTULA TREATMENT FOR THE PERIANAL ABSCESS IN CHILDREN
2023, European Journal of Pediatric SurgeryTreatment of perianal abscess in children: spontaneous drainage or incision-drainage?
2022, Annals of Pediatric Surgery
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Institution: Third Department of General and Paediatric Surgery, Athens University Medical School, “Attikon” University Hospital, Athens, Greece.