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Fistula-in-ano in infants: is nonoperative management effective?
1Department of Pediatric Surgery, Yonsei University College of Medicine, Seoul, Korea.
Insights
Surgical management is more effective for infant fistula-in-ano than nonoperative methods. While nonoperative care avoids surgery, it does not cure the condition, making surgical intervention the preferred treatment for timely resolution.
Area of Science:
- Pediatric Surgery
- Anorectal Disorders
- Infant Health
Background:
- Nonoperative management of fistula-in-ano in infants has shown mixed results.
- Effective treatment strategies for infant fistula-in-ano require further investigation.
Purpose of the Study:
- To determine the most effective treatment methods for fistula-in-ano in infants.
- To compare operative and nonoperative approaches for infant fistula-in-ano.
Main Methods:
- Retrospective review of 310 children with fistula-in-ano or perianal abscess (1991-2000).
- Analysis of 18 pediatric patients with symptom onset <1 year and duration >12 months.
- Review of medical records focusing on treatment outcomes.
Main Results:
- All 18 analyzed patients were male, with a mean symptom duration of 26.6 months.
- Two disease patterns observed: silent fistula after onset (6 patients) and intermittent inflammation (12 patients).
- All patients underwent fistulotomy, with no recurrence during follow-up.
Conclusions:
- Nonoperative management of infant fistula-in-ano avoids anesthesia but does not lead to cure.
- Surgical management, specifically fistulotomy, is more effective and time-efficient for treating infant fistula-in-ano.
- Early surgical intervention is recommended for definitive treatment of pediatric fistula-in-ano.
Purpose:
Recently, a number of studies have reported positive results from the nonoperative management of fistula-in-ano in infancy, although it has not been of use in all patients. The purpose of this study was to discern the effective treatment methods of fistula-in-ano in infants.
Methods:
A retrospective review was done of 310 children who required operative management for fistula-in-ano or perianal abscess between January 1991 and July 2000. Eighteen patients displayed an onset of symptoms at less than 1 year of age and a duration of symptoms longer than 12 months. The authors analyzed these patients' medical records.
Results:
All patients were boys. The mean duration of the symptoms was 26.6 +/- 27.5 months. Fourteen patients had shown an onset of symptoms at less than 6 months of age. The longest duration was 10 years. The patients showed conservative periods of over 12 months because their parents did not want them to undergo surgery. The disease in these patients followed 2 patterns. One (6 patients) was an onset of symptoms followed by a silent fistula-in-ano state. The other (12 patients) was an onset of symptoms followed by an intermittent relapse of inflammation. All patients underwent fistulotomy, and none of them had recurrent fistula during the follow-up period.
Conclusions:
Although the advantages of a nonoperative management of fistula-in-ano in infants include the avoidance of general anesthesia and surgical intervention, the lesions cannot be cured by a period of conservation. Surgical management is more effective in respect to the time factor.
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