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Conservative management of fistula in ano in infants
Y Watanabe1, T Todani, S Yamamoto
1Department of Pediatric Surgery, Kagawa Medical University, Japan.
Insights
Fistula in ano (FIA) and perianal abscess (PAA) in infants often resolve spontaneously within one year. Conservative management is recommended for infants, avoiding surgery until after age two.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Proctology
Background:
- Perianal abscess (PAA) and fistula in ano (FIA) are common in infants.
- The natural history and optimal management of these conditions in children are not fully understood.
Purpose of the Study:
- To analyze the natural course of PAA and FIA in pediatric patients.
- To evaluate the efficacy of conservative management versus surgical intervention in infants.
Main Methods:
- Retrospective analysis of 97 children diagnosed with PAA and/or FIA.
- Data collection included patient demographics, disease course, recurrence rates, and treatment outcomes.
Main Results:
- Nearly 50% of children experienced no recurrent episodes.
- 80% of infants with PAA/FIA recovered spontaneously within the first year.
- Only 6 children required radical surgery after age two; 42% of those with FIA had no recurrence.
- Two-thirds of children with PAA did not progress to FIA.
Conclusions:
- PAA and FIA in infants are likely self-limiting conditions, predominantly resolving within the first year of life.
- Conservative management is recommended for infants, with surgical interventions like fistulotomy or fistulectomy to be avoided.
- Delayed surgical intervention may be considered for children over two years of age if conservative measures fail.
Abstract:
We analyzed the natural course of fistula in ano (FIA) and/or perianal abscess (PAA) in 97 children (male: 90, female: 7) and recommend conservative management in infants. Nearly one-half of these children had no recurrent episodes, and 80% of the infants recovered spontaneously within their 1st year of life. A radical operation was required in only 6 children after 2 years of age. Two-thirds of the children with a PAA did not develop fistula. Of the children who developed FIA, 42% had no recurrence. Although the duration of FIA was relatively longer than that of PAA, 55% of the children were cured within 1 year. PAA and/or FIA in infants is likely to be a period-limited disorder that occurs mainly in infancy and spontaneously resolves within 1 year of life. Fistulotomy or fistulectomy should be avoided in infants.