Elsevier

Journal of Pediatric Surgery

Volume 47, Issue 11, November 2012, Pages 2096-2100
Journal of Pediatric Surgery

Original Article
Surgical treatment of perianal abscess and fistula-in-ano in childhood, with emphasis in children older than 2 years

https://doi.org/10.1016/j.jpedsurg.2012.06.032Get rights and content

Abstract

Background

Anal sepsis in children ranges from perianal abscess to fistula-in-ano. It is mostly observed in boys younger than 2 years. Most are treated conservatively. In contrast, anal sepsis in older children presents significant similarities to that of adults and is predominantly treated surgically. We report our outcomes after surgical treatment of anal abscess and fistula-in-ano in children older than 2 years.

Patients and Methods

Ninety-eight (98) children were operated on for anal abscess (46 patients; 47%) and/or fistula-in-ano (52 patients; 53%). Incision and drainage of the abscess was performed as outpatients. In patients with fistulas, fistulotomy was the main treatment approach. All patients were healthy without risk factors for anal sepsis.

Results

In patients with anal abscess treated with incision and drainage, low recurrence (13%) or fistula formation rates were observed. Most anal fistulas were simple entities. Significant involvement of the anal sphincter was found in 3 (6%) of 52 patients. An abscess cavity between the anal canal and the perianal skin was found in 4 (8%) of 52 patients, and an enlarged cryptic gland was found in 5 (10%) of 52 cases. Fistulotomy was performed in all patients with additional seton placement in 3 (6%) of 52 and a cryptotomy in 5 (10%) of 52 patients.

Conclusions

Anal abscesses in children are easily treated by incision and drainage with low recurrence of perianal sepsis. Fistulas can be treated successfully in most patients with a fistulotomy, whereas complex fistulas are uncommon.

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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    Citation 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].

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Institution: Third Department of General and Paediatric Surgery, Athens University Medical School, “Attikon” University Hospital, Athens, Greece.

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