Nonoperative Management of Fistula-in-Ano
Journal of Pediatric Surgery
June 2000 • Volume 35 • Number 6 • p938 to p939
Nelson G. Rosen, David L. Gibbs, Samuel Z. Soffer, Andrew Hong, Marc Sher, Alberto Peña
Background / Purpose
Fistulotomy is the accepted treatment for infants with perianal fistula. Although recurrence rates range from 0% to 68%.
Based on the experience of a senior colleague who noted that babies suffering from perianal fistula follow a self-limited course the authors decided to determine if this observation was accurate.
Methods
A conservative approach to perianal abscess and fistula was used prospectively in 18 male infants. Abscesses were to be drained only if the baby was very uncomfortable or febrile.
Once a fistula developed the authors continued observation until the fistula healed. Data are expressed as mean ± SD. Mean follow-up period was 37 months.
Results
Mean age at onset of symptoms was 4 ± 3 months. Fistulas developed in 14 patients (77%). All fistulas healed without operation. Four patients had abscesses drained for discomfort (n = 3) or fever (n = 1).
No patient required antibiotics. Mean duration of symptoms was 6 ± 4 months. Four patients in whom fistulas did not form healed after incision (n = 3) or spontaneous drainage (n = 1). All patients currently are asymptomatic.
Conclusions
In healthy neonates, perianal abscess and fistula are self-limited conditions rarely requiring surgical drainage and not requiring antibiotics.
The conservative management of perianal abscess and fistula in healthy infants appears to be safe and effective.
Journal of Pediatric Surgery (Copyright ! 2002 by W.B. Saunders Company)
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