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Sun Y, Hao S, Zhang X, Liang H, Yao Y, Lu J, Wang C. A Systematic Review and Meta-Analysis of Comparing Drainage Alone versus Drainage with Primary Fistula Treatment for the Perianal Abscess in Children. Eur J Pediatr Surg 2024; 34:204-214. [PMID: 37023788 PMCID: PMC11076104 DOI: 10.1055/a-2070-3613] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/28/2023] [Indexed: 04/08/2023]
Abstract
This systematic review and meta-analysis of nonrandomized studies (NRSs) aimed to evaluate the clinical efficacy and safety of two types of surgical interventions (respectively drainage alone and drainage with primary fistula treatment) for perianal abscesses (PAs) in children. Studies from 1992 to July 2022 were searched in 10 electronic databases. All relevant NRSs with available data which compared surgical drainage with or without primary fistula treatment were included. Patients with underlying diseases which led to abscess formation were excluded. The Newcastle-Ottawa Scale was used to assess the risk of bias and quality of the included studies. The outcomes were the healing rate, fistula formation rate, fecal incontinence, and wound healing duration. A total of 16 articles with 1,262 patients were considered suitable for the final meta-analysis. Primary fistula treatment was associated with a significantly higher healing rate when compared with incision and drainage alone (odds ratio [OR]: 5.76, 95% confidence interval [CI]: 4.04-8.22). This aggressive procedure for PA resulted in an 86% reduction in the fistula formation rate (OR: 0.14, 95% CI: 0.06-0.32). Limited data showed patients who underwent primary fistula treatment have a minor effect on postoperative fecal incontinence. Primary fistula treatment demonstrates a better clinical efficacy in promoting the healing rate and decreasing the formation of fistulas in PAs in children. The available evidence for a minor impact on anal function after this intervention is less strong.
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Affiliation(s)
- Yanting Sun
- Department of Proctology, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China
- Institute of Traditional Chinese Medicine Surgery, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China
| | - Shuang Hao
- Department of Proctology, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China
| | - Xi Zhang
- Department of Proctology, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China
| | - Hongtao Liang
- Department of Proctology, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China
| | - Yibo Yao
- Department of Proctology, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China
| | - Jingen Lu
- Department of Proctology, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China
| | - Chen Wang
- Department of Proctology, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China
- Institute of Traditional Chinese Medicine Surgery, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China
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Chakarov D, Hadzhieva E, Kalchev Y, Hadzhiev D. Aerobic Microbiological Spectrum and Antibiotic Resistance in Children Operated for Anorectal Abscesses. J Clin Med 2024; 13:2414. [PMID: 38673687 PMCID: PMC11051477 DOI: 10.3390/jcm13082414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/17/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background: Anorectal abscesses are a relatively rare pathology in childhood. Most often, male children under 1 year of age are affected. The importance of microbiological examination for the diagnosis and treatment of such patients remains debatable among surgeons, resulting in scarce data being available in the literature. We aimed to identify the aerobic microbiological spectrum and antibiotic resistance of isolates in children undergoing operation to treat anorectal abscesses. (2) Methods: We performed a case series of 102 children diagnosed and operated for anorectal abscesses over a period of 10 years (2010-2019). Purulent wound exudate was used for microbiological evaluation, which was subsequently cultured on 5% sheep-blood agar and eosin-methylene blue agar. For microbiological identification, conventional biochemical tests and semi-automated (API 20, bioMerieux, Marcy-l'Étoile, France) tests were used, as well as automated systems (Vitek-2 Compact, bioMerieux, France). Antimicrobial susceptibility testing was performed by the disk diffusion method of Bauer-Kirby and by determining the minimal inhibitory concentrations for glycopeptides. The results were interpreted according to the EUCAST standard for the corresponding year. (3) Results: Microbiological testing in children operated for anorectal abscesses mainly identified the gut commensals that normally reside in the rectal mucosa. Monocultures were found in just over half of the cases. Escherichia coli, Klebsiella pneumoniae complex, and Proteus mirabilis were the most frequently isolated. In addition, Staphylococcus aureus was found in 7% of patients. In Gram-negative bacteria, antibiotic resistance was most often observed in penicillins, cephalosporins, sulfonamides, and fluoroquinolones. (4) Conclusions: The increasing rates of antimicrobial resistance impose the need for the local monitoring of circulating commensal bacteria associated with anorectal abscesses in children to guide antibiotic therapy when indicated.
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Affiliation(s)
- Dzhevdet Chakarov
- Section of General Surgery, Department of Propedeutics of Surgical Diseases, Faculty of Medicine, Medical University of Plovdiv, 4001 Plovdiv, Bulgaria; (D.C.); (D.H.)
- First Clinic of Surgery, University Hospital St. George, 4001 Plovdiv, Bulgaria
| | - Elena Hadzhieva
- Section of General Surgery, Department of Propedeutics of Surgical Diseases, Faculty of Medicine, Medical University of Plovdiv, 4001 Plovdiv, Bulgaria; (D.C.); (D.H.)
- First Clinic of Surgery, University Hospital St. George, 4001 Plovdiv, Bulgaria
| | - Yordan Kalchev
- Department of Medical Microbiology and Immunology “Prof. Dr. Elissay Yanev”, Faculty of Medicine, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria;
- Laboratory of Microbiology, University Hospital St. George, 4002 Plovdiv, Bulgaria
| | - Dimitar Hadzhiev
- Section of General Surgery, Department of Propedeutics of Surgical Diseases, Faculty of Medicine, Medical University of Plovdiv, 4001 Plovdiv, Bulgaria; (D.C.); (D.H.)
- First Clinic of Surgery, University Hospital St. George, 4001 Plovdiv, Bulgaria
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Ding C, Chen Y, Yan J, Wang K, Tan SS. Risk factors for therapy failure after incision and drainage alone for perianal abscesses in children. Front Pediatr 2024; 12:1342892. [PMID: 38390277 PMCID: PMC10881786 DOI: 10.3389/fped.2024.1342892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/16/2024] [Indexed: 02/24/2024] Open
Abstract
Background It is well known that recurrent perianal abscesses (PAs) and fistula-in-ano (FIA) are the main causes of therapy failure following incision and drainage (I&D) for PAs. But few studies have focused on the risk factors for therapy failure after I&D for PAs in children. In this study, we retrospectively examine the risk factors for therapy failure after I&D for PAs in children in a pediatric tertiary care institution. Methods A retrospective review of all outpatient children with PA treated by I&D at Beijing Children's Hospital between January 2021 and December 2022 was performed. A follow-up was conducted in October 2023. Patients with other predisposing factors for perianal infection, such as inflammatory bowel disease, hematologic tumor, and anorectal surgery, were excluded from this study. Logistic regression yielding odds ratios (ORs) was used to assess the significance of variables for therapy failure. Results Of 160 children initially identified, follow-up was available for 146, with a total of 172 treatments. A total of 91% of children were male. The median (interquartile range) age at I&D was 2 (1, 15) months. The median follow-up duration was 20 (14, 25) months. Therapy failure occurred in 25 (15%) treatments performed for the prevention of recurrence of PA and in 35 (20%) treatments for the prevention of development of FIA. In the univariate analysis, a history of PA (P = 0.001), history of I&D (P = 0.014), and multilocal occurrence (P = 0.003) were associated with therapy failure. A sitz bath after I&D (P = 0.016) and regular cleaning of the wound after I&D (P = 0.024) were associated with therapy success. In the multivariate analysis, a history of PA (P = 0.015, OR = 3.374) and multilocal occurrence (P = 0.012, OR = 4.649) were independently associated with therapy failure. Regular cleaning of the wound (P = 0.017, OR = 0.341) and sitz bath (P = 0.001, OR = 0.128) after I&D were independently associated with therapy success. Conclusions A history of PA and multilocal occurrence were predictor factors for therapy failure before I&D. Regular cleaning of the wound and sitz bath after I&D were protective factors for therapy success. Therefore, regular cleaning of the wound and sitz bath after I&D should be emphasized in all children with PAs, especially in those with a history of PA and multilocal occurrence.
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Affiliation(s)
- CaiLin Ding
- Department of General Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - YaJun Chen
- Department of General Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - JiaYu Yan
- Department of General Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Kai Wang
- Department of General Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Sarah Siyin Tan
- Department of General Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
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Yin W, Li Y, Zhang J, Jiao Y, Pei W, Xu X, Fan M, Xu J, Zhou Y, Wang S, Wei Y. Natural course of perianal abscess in infants: a real-world study. Sci Rep 2023; 13:18416. [PMID: 37891236 PMCID: PMC10611711 DOI: 10.1038/s41598-023-45751-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 10/23/2023] [Indexed: 10/29/2023] Open
Abstract
Natural course of perianal abscess (PA) in infancy remains obscure. This study aimed to investigate the natural course of infants with PA after conservative treatment. A retrospective cohort study was conducted in infants with PA who were treated conservatively (due to the parents' refusal of surgery), for more than 2 months between 2014 and 2020 at a single tertiary center. 153 patients (149 boys and 4 girls) were identified. The median follow-up was 5.3 years (range 3-8.2 years). Initially, 119 patients (77.8%) were completely cured by conservative treatment, and 34 (22.2%) failed. Among the 34 patients, 23 continued conservative treatment (20 cure, 3 fistula formation) and 11 underwent surgery. After conservative treatment, the rate of fistula formation, abscess recurrence, and new-onset abscess were 15.0%, 4.6%, and 6.5%, respectively. Overall, 139 patients (90.8%) were cured conservatively without surgery, and 11 (7.2%) underwent surgical management. In addition, 3 (2.0%) patients developed fistula-in-ano (under observation). PA in infants may be a time-limited and self-limited condition. Conservative management should be the first choice of treatment in most cases. Longer periods of conservative treatment may achieve better clinical outcomes in selected cases. There will be a percentage of patients (about 10%) that would require surgical treatment.
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Affiliation(s)
- Wanbin Yin
- Department of Anorectal Surgery, Affiliated Hospital of Jining Medical University, 129 Hehua Road, Jining, 272067, China
| | - Yansen Li
- Department of Anorectal Surgery, Affiliated Hospital of Jining Medical University, 129 Hehua Road, Jining, 272067, China
| | - Jingfeng Zhang
- Department of Anorectal Surgery, Affiliated Hospital of Jining Medical University, 129 Hehua Road, Jining, 272067, China
| | - Yang Jiao
- Department of Anorectal Surgery, Affiliated Hospital of Jining Medical University, 129 Hehua Road, Jining, 272067, China
| | - Wenju Pei
- Department of Anorectal Surgery, Affiliated Hospital of Jining Medical University, 129 Hehua Road, Jining, 272067, China
| | - Xiangjun Xu
- Department of Anorectal Surgery, Affiliated Hospital of Jining Medical University, 129 Hehua Road, Jining, 272067, China
| | - Mingfeng Fan
- Department of Anorectal Surgery, Affiliated Hospital of Jining Medical University, 129 Hehua Road, Jining, 272067, China
| | - Juan Xu
- Department of Anorectal Surgery, Affiliated Hospital of Jining Medical University, 129 Hehua Road, Jining, 272067, China
| | - Yue Zhou
- Department of Anorectal Surgery, Affiliated Hospital of Jining Medical University, 129 Hehua Road, Jining, 272067, China
| | - Shuai Wang
- Department of Anorectal Surgery, Affiliated Hospital of Jining Medical University, 129 Hehua Road, Jining, 272067, China.
| | - Yanhua Wei
- Department of Infectious Diseases, Affiliated Hospital of Jining Medical University, 129 Hehua Road, Jining, 272067, China.
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Lin CA, Chou CM, Huang SY, Chen HC. The optimal primary treatment for pediatric perianal abscess and anal fistula: A systemic review and meta-analysis. J Pediatr Surg 2023:S0022-3468(23)00091-X. [PMID: 36894443 DOI: 10.1016/j.jpedsurg.2023.01.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 01/20/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Perianal abscesses and anal fistulas are common. The principle of intention-to-treat has not been considered in previous systemic reviews. Thus, the comparison between primary and post-recurrence management was confused, and the recommendation of primary treatment is obscure. The current study aims to identify the optimal initial treatment for pediatric patients. METHODS Using PRISMA guidelines, studies were identified from MEDLINE, EMBASE, PubMed, Cochrane Library, and Google Scholar without any language or study design restriction. The inclusion criteria include original articles or articles with original data, studies of management for a perianal abscess with or without anal fistula, and patient age of <18 years. Patients with local malignancy, Crohn's disease, or other underlying predisposing conditions were excluded. Studies without analyzing recurrence, case series of <5, and irrelevant articles were excluded in the screening stage. Of the 124 screened articles, 14 articles had no full texts or detailed information. Articles written in a language other than English or Mandarin were translated by Google Translation first and confirmed with native speakers. After the eligibility process, studies that compared identified primary managements were then included in the qualitative synthesis. RESULTS Thirty-one studies involving 2507 pediatric patients met the inclusion criteria. The study design consisted of two prospective case series of 47 patients and retrospective cohort studies. No randomized control trials were identified. Meta-analyses for recurrence after initial management were performed with a random-effects model. Conservative treatment and drainage revealed no difference (Odds ratio [OR], 1.222; 95% Confidential interval [CI]: 0.615-2.427, p = 0.567). Conservative management had a higher risk of recurrence than surgery without statistical significance (OR 0.278, 95% CI: 0.109-0.707, p = 0.007). Compared with incision/drainage, surgery can prevent recurrence remarkably (OR 4.360, 95% CI: 1.761-10.792, p = 0.001). Subgroup analysis of different approaches within conservative treatment and operation was not performed for lacking information. CONCLUSION Strong recommendations cannot be made due to the lack of prospective or randomized controlled studies. However, the current study based on real primary management supports initial surgical intervention for pediatric patients with perianal abscesses and anal fistula to prevent recurrence. LEVEL OF EVIDENCE Type of study: Systemic review; Evidence level: Level II.
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Affiliation(s)
- Chih-An Lin
- Division of Colorectal Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chia-Man Chou
- Division of Pediatric Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Sheng-Yang Huang
- Division of Pediatric Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
| | - Hou-Chuan Chen
- Division of Pediatric Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
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Doerner J, Seiberth R, Jafarov S, Zirngibl H, Boenicke L. Risk factors for therapy failure after surgery for perianal abscess in children. Front Surg 2022; 9:1065466. [PMID: 36589625 PMCID: PMC9797814 DOI: 10.3389/fsurg.2022.1065466] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
Purpose The role of surgery in managing perianal abscesses in the pediatric population is debatable, and data on recurrence risk is rare. This study aimed to evaluate the efficiency of surgery for a perianal abscess in children and identify parameters that predict recurrence. Methods We performed a retrospective review of all children younger than age 14 requiring surgery for a perianal abscess from 2000 to 2018. Results Out of 103 enrolled patients, 27 (26%) had recurrent perianal disease. Recurrences appeared after a median of 5 months (range: 1-18 months), in 12 cases as perianal abscess and 15 cases as fistula in ano. Anal fistula probing was performed in 33% of all patients, of which 16 (15%) underwent fistulotomy. In univariate analysis, older age (p = 0.034), fistula probing (p = 0.006) and fistulotomy (p = 0.009) was associated with treatment success. History of perianal abscess, multilocal occurrence, and the presence of enteric flora in wound swabs was associated with treatment failure (p = 0.002, OR = 0.032). In multivariate analysis, anal fistula probing was independently associated with treatment success (p = 0.019, OR = 22.08), while the history of perianal abscess was associated with treatment failure (p = 0.002, OR = 0.032). Conclusion Our study identified probing for fistula as a predictor of therapy success, while the history of perianal abscess was identified as a predictor of treatment failure. Therefore, in all children with perianal abscess, fistula probing and if present, fistulotomy should be performed.
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Affiliation(s)
- Johannes Doerner
- Department of General and Visceral Surgery, Helios University Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany,Correspondence: Johannes Doerner
| | - Rose Seiberth
- Department of General and Visceral Surgery, Helios University Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | - Sakhavat Jafarov
- Department of General and Visceral Surgery, Helios University Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | - Hubert Zirngibl
- Department of General and Visceral Surgery, Helios University Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | - Lars Boenicke
- Department of General and Visceral Surgery, Helios University Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
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Ding YW, Yin HQ, Liang HT, Lu JG, Wang B, Wang C. Can transcutaneous perianal ultrasonography be the first-line diagnostic instrument for evaluating pediatric perianal fistulas? Gastroenterol Rep (Oxf) 2022; 10:goac071. [PMID: 36457375 PMCID: PMC9707404 DOI: 10.1093/gastro/goac071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/14/2022] [Accepted: 11/04/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Pediatric perianal fistula is a common disorder. It is more difficult to detect the fistula tract and internal opening (IO) in children than in adults. This study aimed to evaluate the clinical diagnostic value of transcutaneous perianal ultrasound for children with perianal fistula. METHODS A retrospective review was conducted by analysing the preoperative transcutaneous perianal ultrasound and intraoperative exploration results of 203 consecutive patients who were <3 years old and diagnosed with perianal fistula. Analyses were conducted to evaluate the accuracy and consistency of utilizing the transcutaneous perianal ultrasound in the diagnosis of the complexity and location of the IO of perianal fistulas. RESULTS Compared with intraoperative exploration, the preoperative transcutaneous perianal ultrasonography has almost perfect agreement (Kappa = 0.881, P < 0.001) in the diagnosis of fistula tract complexity and IO with a sensitivity of 92% and a specificity of 97%. In addition, both intraoperative exploration and transcutaneous perianal ultrasound diagnosis showed high consistency in the identification of the IO of perianal fistulas (Quadrant I Kappa = 0.831, Quadrant II Kappa = 0.773, Quadrant III Kappa = 0.735, Quadrant IV Kappa = 0.802, all P < 0.01). The IOs were mainly distributed in Quadrants IV and II in both simple and complex fistulas. CONCLUSIONS Transcutaneous perianal ultrasound, as a non-invasive and simple imaging technique, showed high accuracy in the diagnosis and identification of the fistula classification and IO location. It could be considered a first-line diagnostic instrument for evaluating perianal fistulas among children.
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Affiliation(s)
| | | | - Hong-Tao Liang
- Department of Proctology, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China
| | - Jin-Gen Lu
- Department of Proctology, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China
| | - Bo Wang
- Shanghai Shumiao Health Cloud Co. Ltd, Shanghai, P. R. China
| | - Chen Wang
- Corresponding author. Longhua Hospital affiliated to Shanghai University of TCM, No. 725 South Wanping Road, Shanghai 200032, P. R. China. Tel: +86-18917763340; Fax: +86-21-64698173;
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Mekonen Y. A Diagnostic Approach to a Rare Case of a Recto-Cutaneous Fistula Following Recurrent Perianal Abscess: A Case Report. OPEN ACCESS SURGERY 2022. [DOI: 10.2147/oas.s360182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Yin W, Li L, Su L, Wang S. Incision and Drainage With Primary Fistulotomy of Perianal Abscess Is Safe and Effective in Neonates: A Long-Term Follow-Up Study. Front Pediatr 2022; 10:862317. [PMID: 35601425 PMCID: PMC9120821 DOI: 10.3389/fped.2022.862317] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/06/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Perianal abscess (PA) in neonates is poorly understood, and its management remains controversial. The aim of this study was to compare incision and drainage (ID) with or without primary fistulotomy in the management of neonatal first-time PA. METHODS A retrospective comparative study was conducted for neonates with first-time PA treated with incision and drainage with primary fistulotomy (IDF) vs. ID between 2008 and 2017. RESULTS In total, 138 patients (137 boys and 1 girl) were identified; 65 in the IDF group and 73 in the ID group. The median follow-up was 6.5 years (range 4-13 years). Baseline characteristics were similar between the 2 groups. The cure rate in the IDF group (98.5%, 64/65) was significantly higher than that in the ID group (80.8%, 59/73; p = 0.001). The rate of fistula formation in the IDF group (1.5%, 1/65) was significantly lower than that in the ID group (13.7%, 10/73; p = 0.01). The rate of abscess recurrence was not statistically different (p = 0.12), even though the IDF group (0%, 0/65) seemed to have a better outcome than the ID group (5.5%, 4/73). No fecal incontinence was observed in any of our patients. CONCLUSIONS First-time PA in neonates can be treated safely and effectively by the IDF or by ID alone. The former may be advantageous over the latter in terms of the rate of cure and fistula formation.
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Affiliation(s)
- Wanbin Yin
- Department of Anorectal Surgery, Affiliated Hospital of Jining Medical University, Jining, China
| | - Laian Li
- Department of Anorectal Surgery, Affiliated Hospital of Jining Medical University, Jining, China
| | - Lin Su
- Department of Pediatric Surgery, Affiliated Hospital of Jining Medical University, Jining, China
| | - Shuai Wang
- Department of Anorectal Surgery, Affiliated Hospital of Jining Medical University, Jining, China
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10
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Roskam M, de Meij T, Gemke R, Bakx R. Perianal Abscesses in Infants Are Not Associated With Crohn's Disease in a Surgical Cohort. J Crohns Colitis 2020; 14:773-777. [PMID: 31120097 DOI: 10.1093/ecco-jcc/jjz105] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIMS The aim of this study is to search for an association between infantile perianal abscesses and [development of] Crohn's disease in a surgical population of children. METHODS Patients who were surgically treated in the Amsterdam UMC between January 2000 and December 2014 were included in this retrospective cohort study. Data collected include: sex, date of birth, underlying conditions, age of onset, additional symptoms, pus cultures, endoscopic examination, histological examination, magnetic resonance imaging, faecal calprotectin levels, antibiotic treatment, surgical treatment strategy, and number of recurrences. Follow-up data were gathered from medical records and by contacting the patients and/or parents or the general practitioner. RESULTS The study consisted of 62 patients of whom 60 were boys. Median age was 5 months [range 0-17 months]; 92% were under 1 year of age at diagnosis. A minority of patients had accompanying symptoms. In total, 72 abscesses were treated, 19 fistulas and 23 abscesses with fistula-in-ano. Follow-up data of 46 patients [74%] were available; none of the patients developed Crohn's disease. CONCLUSIONS We found no association between isolated perianal abscesses as presenting symptom in early childhood and [development of] Crohn's disease. In young infants with isolated perianal disease, risk for inflammatory bowel disease seems low. In this specific population there seems no place for routine performance of endoscopic investigations. One should always take the risk of very-early-onset inflammatory bowel disease into account. Further research with a larger cohort of children and a longer follow-up time is required.
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Affiliation(s)
- Mariëlle Roskam
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatrics, Amsterdam, The Netherlands
| | - Tim de Meij
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Gastroenterology, Amsterdam, The Netherlands
| | - Reinoud Gemke
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatrics, Amsterdam, The Netherlands
| | - Roel Bakx
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric Surgical Center Amsterdam, Amsterdam, the Netherlands
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Boenicke L, Doerner J, Wirth S, Zirngibl H, Langenbach MR. Efficacy of conservative treatment of perianal abscesses in children and predictors for therapeutic failure. Clin Exp Pediatr 2020; 63:272-277. [PMID: 32408417 PMCID: PMC7374001 DOI: 10.3345/cep.2019.00969] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 12/31/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The optimal management of perianal abscess in children is controversial. PURPOSE To evaluate the efficiency of conservative treatment of perianal abscess in children and identify parameters that predict therapy failure. METHODS All cases of children younger than 14 years of age with perianal abscesses between 2001-2016 were evaluated. RESULTS Of the 113 enrolled patients, 64 underwent subsequent surgery for advanced disease (primary surgery group). Conservative treatment was initiated in 49 patients (primary conservative group) but was stopped because of inefficiency in 25 patients, who were referred for surgery after a median 7.03 days (range, 2 to 16 days). The other 24 patients (48%) initially achieved complete remission after conservative treatment, but 10 were readmitted after a median 34 months (range, 3 to 145 months) with recurrent disease. There were no significant differences in permanent success after conservative treatment between infants (10 of 29, 34%) and older children (4 of 20 [20%], P=0.122). Overall, conservative treatment alone was effective in only 14 of 113 patients. Recurrence after surgery occurred in 16 patients (25%) in the primary surgery group and 11 patients (22%) in the primary conservative group (P=0.75). Univariate analysis of predictors for conservative treatment failure revealed inflammatory values (C-reactive protein and white blood count, P=0.017) and abscess size (P=0.001) as significant parameters, whereas multivariate analysis demonstrated that only abscess size (odds ratio, 3.37; P=0.023) was significant. CONCLUSION Conservative treatment of perianal abscess is permanently efficient in only a minority of children but is not associated with a higher recurrence rate after subsequent surgery. Abscess size is a predictor for therapy failure.
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Affiliation(s)
- Lars Boenicke
- Department of General and Visceral Surgery, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany
| | - Johannes Doerner
- Department of General and Visceral Surgery, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany
| | - Stefan Wirth
- Department of Pediatrics, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany
| | - Hubert Zirngibl
- Department of General and Visceral Surgery, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany
| | - Mike Ralf Langenbach
- Department of General and Visceral Surgery, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany.,Department of General and Visceral Surgery and Coloproctology, Helios Clinic Oberhausen, Oberhausen, Germany
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12
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Samuk I, Avinadav E, Barak U, Seguier E, Steiner Z, Freud E. Perianal abscess in infants: Amenable to conservative treatment in selected cases. Pediatr Int 2019; 61:1146-1150. [PMID: 31469939 DOI: 10.1111/ped.13996] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 07/04/2019] [Accepted: 07/29/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Perianal abscess is a common surgical condition in daily pediatric practice. Management is a subject of controversy and a variety of approaches are practiced. While the most frequent approach is drainage with/without fistulotomy, the superiority of this approach and the place of conservative approach has not been established. The aim of this study was to evaluate the outcomes of conservative approach in selected cases of perianal abscesses in infants. METHODS Data of 19 patients aged <24 months treated conservatively for perianal abscess at a tertiary hospital in 2014-2018 were retrospectively reviewed. RESULTS Criteria for a conservative approach were: spontaneous drainage into the anal canal (n = 8) or perianal skin (n = 4), and phlegmonous infiltrate with fluid collection detected on ultrasound (n = 7). Mean age at symptom onset was 8.4 months. Twelve patients were managed for the first time. Previous care in seven patients included 1-4 drainage procedures (n = 4), spontaneous drainage (n = 1) and antibiotics (n = 2). Five patients were on oral antibiotics at presentation. After diagnosis, 18 patients received i.v. antibiotics and one, oral antibiotics. Three patients (15.7%) ultimately required surgical drainage; two were lost to follow up. During follow up (mean, 22.4 months) four patients (28.5%) had a single recurrent episode; abscess in three (managed conservatively in two and surgically in one) and fistula-in-ano in one patient that healed spontaneously. Thus, surgical intervention was prevented in 13/17 patients (76.4%) available for follow up. CONCLUSIONS Perianal abscess in infants is amenable to conservative management in selected cases. Avoiding surgical intervention is advantageous, especially given the high recurrence rate.
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Affiliation(s)
- Inbal Samuk
- Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Avinadav
- Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Barak
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of, Anesthesia, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Emmanuelle Seguier
- Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zvika Steiner
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pediatric Surgery, Meir Medical Center, Kfar Sava, Israel
| | - Enrique Freud
- Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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13
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Sueyoshi R, Lane GJ, Kusafuka J, Yamataka A, Doi T. Combination therapy with traditional medicines for perianal abscess in children. Pediatr Int 2019; 61:1025-1029. [PMID: 31394015 DOI: 10.1111/ped.13988] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 05/10/2019] [Accepted: 06/05/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Combination therapy with two different traditional medicine formulations called hainosankyuto and juzentaihoto (TJ-122 and TJ-48; Tsumura & Co, Tokyo, Japan) may be effective for perianal abscess (PA), but their effectiveness has not been established. The present study investigated the effectiveness of combination therapy with TJ-122 and TJ-48 as the most effective conservative treatment for PA. METHODS We identified 69 patients with PA under 2 years of age and divided them into four groups according to the formulations used: group 1, TJ-122 (n = 17); group 2, TJ-48 (n = 14); group 3, TJ-122 and TJ-48 (n = 19); and group 4, no traditional medicines (n = 19). Treatment was continued for 3-6 months after resolution of the PA in groups 1 and 2, and for 1 year in group 3. Age at presentation, duration of purulent discharge (PD), frequency of surgical intervention (incision and drainage [ID]; fistulotomy/fistulectomy), and recurrence rates were statistically analyzed. RESULTS Mean age (months) was 8.6 ± 9.2, 6.9 ± 7.3, 5.2 ± 4.7, and 3.8 ± 3.1 in groups 1, 2, 3, and 4, respectively (P = n.s.). Mean PD (weeks) was 2.5 ± 2.2, 7.1 ± 10.8, 2.0 ± 0.0, and 2.7 ± 1.0, respectively. Duration of PD was significantly longer in group 2 than in groups 1 and 3 (P < 0.05). Mean number of ID procedures was 1.0 ± 0.2, 2.3 ± 0.5, 0, and 1.6 ± 0.2, respectively. Group 1 had significantly less ID than group 2 (P < 0.01). Recurrence rates were 6%, 36%, 0%, and 32%, respectively. Groups 1 and 3 had significantly less recurrence than group 2 (P < 0.05), and group 3 had significantly less recurrence than group 4 (P < 0.01). CONCLUSIONS Combination therapy with TJ-122 and TJ-48 decreased recurrence and surgical intervention to zero in this study, demonstrating high effectiveness for treating PA in children.
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Affiliation(s)
- Ryo Sueyoshi
- Department of Pediatric Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center, Urayasu, Chiba, Japan
| | - Geoffrey J Lane
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Junichi Kusafuka
- Department of Pediatric Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center, Urayasu, Chiba, Japan
| | - Atsuyuki Yamataka
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Takashi Doi
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
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14
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Perianal abscess in children: A paediatric infectious disease perspective. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.anpede.2018.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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15
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Villamil V, Pérez-Etchepare Figueroa EL, Barrientos Fernández MG, Gómez Culebras MA. [An atypical presentation of a peri-anal fistula]. An Pediatr (Barc) 2019; 92:176-177. [PMID: 31126868 DOI: 10.1016/j.anpedi.2018.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/01/2018] [Accepted: 12/29/2018] [Indexed: 10/26/2022] Open
Affiliation(s)
- Vanesa Villamil
- Servicio de Cirugía Pediátrica, Hospital Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Tenerife, España.
| | | | | | - Mario Alberto Gómez Culebras
- Servicio de Cirugía Pediátrica, Hospital Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Tenerife, España
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Peng X, Hu X, Salazar MA. First case in China of vaccine-associated poliomyelitis after sequential Inactivated and bivalent oral polio vaccination. Vaccine 2019; 37:751-754. [PMID: 30630693 DOI: 10.1016/j.vaccine.2018.12.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 12/04/2018] [Accepted: 12/07/2018] [Indexed: 12/01/2022]
Abstract
A 16 week newborn vaccinated with bOPV 4 weeks after his first routine IPV vaccination. Nineteen days later, asymmetrical paralysis was developed on his legs, and it was diagnosed to be VAPP. Perianal abscess is suspected to be a risk factor based on some limited results of retrospective studies in China. This is a risk factor similar to the multiple intramuscular injections found by researchers in last century. The two risk factors remind us that, apart from the routine infection route of the fecal to mouth and intestinal tract, skin injury (ulceration) exposure pathway should not be ignored as another possible way of causing polio, for the local injury and lesions of the skin may increase the possibility of oral poliovirus vaccine's entry into the body. As a result, to further reduce the incidence of VAPP, bOPV should be avoided for perianal abscess. If there is perianal abscess, skin injury, or if injection is unavoidable after bOPV vaccination of an infant, much attention should be paid to the treatment and cleaning of infant feces.
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Affiliation(s)
- Xiangdong Peng
- Shanghai University of Medicine and Health Sciences, China; Beijing Yi'an Research Center for Health and Immunization, China
| | - Xiaojiang Hu
- School of Social Development and Public Policy, Beijing Normal University, China
| | - Miguel A Salazar
- School of Social Development and Public Policy, Beijing Normal University, China.
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17
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[Perianal abscess in children: A pediatric infectious disease perspective]. An Pediatr (Barc) 2018; 90:370-375. [PMID: 29880418 DOI: 10.1016/j.anpedi.2018.03.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/13/2018] [Accepted: 03/14/2018] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION There are limited data on the aetiology and management of perianal abscesses (PAs). The aim of this retrospective study was to define the characteristics of children with PAs; describe our experience with PA from the perspective of paediatric infectious medicine and determine the factors that influence clinical outcomes. METHODS We performed a retrospective review of cases of PA in children with no underlying disease managed in a tertiary referral hospital between January 2005 and July 2015. We collected data on demographic characteristics, symptoms, abscess size and location, abscess recurrences, laboratory and microbiological findings, treatment modalities, diagnosis of systemic illness at the end of the diagnostic workup and clinical outcomes. RESULTS We included a total of 47 patients in the study, with a predominance of male patients (93.6 vs 6.4%, P<.001). The median age was 7.7 months (IQR 1.8-13.7 months), and 40 children (85.1%) were younger than 2 years of age. Four PAs drained spontaneously and 7 healed without need of drainage (23.4%). Drainage by simple incision was applied to 36 patients (76.5%) and six PAs required fistulotomy (12.7%). Recurrent abscesses were found in 25 patients (53.1%). Three patients with recurrent PA were diagnosed with inflammatory bowel disease at the end of the diagnostic evaluation. CONCLUSIONS Based on the findings of our study, measurement of white blood cell counts and serum levels of acute phase reactants may be useful in the initial evaluation of children with PA. In light of the high relapse rates observed in surgically managed patients, it seems reasonable to use a conservative approach in patients aged less than 2 years.
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18
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Perianale Abszesse und Fisteln im Säuglings- und Kleinkindalter. Monatsschr Kinderheilkd 2017. [DOI: 10.1007/s00112-017-0388-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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19
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Efficacy of an anal fistula plug for fistulas-in-Ano in children. J Pediatr Surg 2017; 52:1280-1282. [PMID: 28209416 DOI: 10.1016/j.jpedsurg.2017.01.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 01/25/2017] [Accepted: 01/28/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND In children, perianal abscesses have a good prognosis and often heal with age. However, some perianal abscesses are refractory to treatment and remain as fistulas-in-Ano. Treatment with a Surgisis Anal Fistula Plug® has been reported as a new method of treatment for fistulas. In adults, the plug has been reported to cause little pain and have a high cure rate, but there have been no reported cases of its use in children. PURPOSE This study was designed to analyze the efficacy of the plug for closure of refractory fistulas in children. METHODS Since the plug has not been approved as a medical device in Japan, application for its use was submitted to the ethics committee of our university, and approval was granted, marking the first use of the plug in Japan. We classified refractory fistulas as those treated for 6months or longer and remaining unhealed, even after 1year of age, despite continued conservative treatment. The plug was used in 11 refractory fistulas in 8 children. RESULTS Eight of 11 fistulas (72.7%) were successfully treated. Three fistulas recurred, and fistulectomies were performed. No sequelae were observed after AFP treatment. CONCLUSION The plug was effective even for closure of refractory fistulas without sequelae in children. LEVELS OF EVIDENCE Treatment Study, Level IV.
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20
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Emile SH, Elfeki H, Abdelnaby M. A systematic review of the management of anal fistula in infants. Tech Coloproctol 2016; 20:735-744. [PMID: 27663698 DOI: 10.1007/s10151-016-1536-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 09/05/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Fistula-in-ano (FIA) in infants differs, in several ways, from FIA in adults. The current review aims to assess FIA in infants less than 2 years old and to illustrate the outcome of different treatment modalities described in the literature. METHODS An organized search of the English literature over the past 25 years was conducted according to the preferred reporting items for systematic reviews and meta-analyses guidelines. Electronic databases and Google Scholar were searched for articles focusing on management of FIA in infants. RESULTS Fourteen studies were eligible for this review. Variables analyzed comprised patient characteristics, type of FIA, methods of treatment, recurrence, and postoperative complications. The studies included comprised total of 490 infants, 89 % of them less than 1 year old. Most patients (97.5 %) were males with a median age of 7 months. Around 20 % of patients with FIA underwent conservative treatment initially, and 73 % of them achieved complete resolution. Surgery was performed on 86 % of the infants. Fistulotomy accounted for 65 % of the procedures performed and was associated with a higher recurrence rate than fistulectomy (6.6 vs. 1.1 %, respectively). Complications of surgical management occurred in 2.6 % of the patients. FIA typically occurs in male infants, mainly under 1 year of age. Almost all fistulae in this age group are low. CONCLUSIONS The majority of the studies reviewed evaluated surgical treatment of FIA. However, the few studies that employed conservative treatment reported complete resolution of FIA in most infants. Fistulotomy was the most commonly performed surgery for FIA and was associated with fewer complications, yet a higher recurrence rate than fistulectomy.
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Affiliation(s)
- S H Emile
- Department of General Surgery, Faculty of Medicine, Mansoura University Hospital, Elgomhuoria Street, Mansoura, Egypt.
| | - H Elfeki
- Department of General Surgery, Faculty of Medicine, Mansoura University Hospital, Elgomhuoria Street, Mansoura, Egypt
| | - M Abdelnaby
- Department of General Surgery, Faculty of Medicine, Mansoura University Hospital, Elgomhuoria Street, Mansoura, Egypt
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Preliminary results of video-assisted anal fistula treatment (VAAFT) in children. Tech Coloproctol 2016; 20:279-285. [PMID: 26956836 DOI: 10.1007/s10151-016-1447-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 01/25/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Anal fistula is a common acquired anorectal disorder in children. Treatment methods that have been used are associated with inconsistent results and possible serious complications. In 2011 a minimally invasive approach, video-assisted anal fistula treatment (VAAFT) was described for adult patients. The aim of the present study was to assess the first series of pediatric patients treated with VAAFT. METHODS All patients who underwent VAAFT between August 2013 and May 2015 were included. Demographics, clinical features, preoperative imaging, surgical details, outcome, and medium-term data were prospectively collected for each patient. RESULTS Thirteen procedures were performed in nine patients. The male to female ratio was 8:1, and the median age was 9.6 years. Five fistulas were idiopathic, three iatrogenic, and one associated with Crohn's disease. Eight complete VAAFT procedures were performed. The remaining five procedures were either fistuloscopy and cutting seton placement or fistuloscopy and electrocoagulation, both without mucosal sleeve. The median length of surgery was 41 min. The median hospital stay was 24 h, and the median length of follow-up was 10 months. Resolution of the fistula was observed in all patients who underwent a complete VAAFT. In four out of five patients who underwent an incomplete procedure (without mucosal sleeve), the fistula recurred. No incontinence or soiling was reported in the medium term. CONCLUSIONS VAAFT proved to be feasible and safe in children. It also proved to be versatile as it could be applied to fistulas of different etiologies. The key to success seems to be an adequate mucosal sleeve. Older children and adolescents benefit most from VAAFT which is a valid alternative to available surgical procedures.
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Outcomes of Various Interventions for First-Time Perianal Abscesses in Children. BIOMED RESEARCH INTERNATIONAL 2016; 2016:9712854. [PMID: 26881235 PMCID: PMC4736375 DOI: 10.1155/2016/9712854] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/16/2015] [Accepted: 12/17/2015] [Indexed: 12/15/2022]
Abstract
Introduction. In children treated surgically for first-time perianal abscesses, discovery and excision of concomitant fistulas may also be warranted. Aim. To evaluate children of varying age after incision and drainage of first-time perianal abscesses, examining recurrences rates with and without search for a fistula. Method. A retrospective review was conducted, analyzing children (ages 0–15 years) treated for first-time perianal abscesses at a tertiary pediatric surgical center, with a minimum follow-up of 6 months. Results. A total of 104 patients subjected to 112 treatments for first-time perianal abscesses were eligible. Surgical procedures constituted 84 (75%) of treatments, searching for fistulas in 49 (58%). In 34 (69%), fistulas were confirmed and treated. In the surgically treated subset, the recurrence rate was higher if no attempt was made to exclude a fistula (46%), as opposed to confirmed absence of a fistula (27%) or concurrent fistulotomy (9%; p = 0.02). Younger patients showed a higher recurrence rate (12/26; 46%), compared with older counterparts (11/58; 19%) (p = 0.002). Conclusion. In children surgically treated for first-time perianal abscess, recurrence rates appear to be lowered by locating and treating coexisting fistulas.
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Evaluation of the efficacy of incision and drainage versus hainosankyuto treatment for perianal abscess in infants: a multicenter study. Surg Today 2014; 45:1385-9. [DOI: 10.1007/s00595-014-1058-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 10/08/2014] [Indexed: 10/24/2022]
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Inoue M, Sugito K, Ikeda T, Kawashima H, Hanada M, Furuya T, Ohashi K, Koshinaga T. Long-term results of seton placement for fistula-in-ano in infants. J Gastrointest Surg 2014; 18:580-3. [PMID: 24065365 DOI: 10.1007/s11605-013-2351-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 09/03/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND The present study aimed to assess the long-term results of seton placement for fistula-in-ano (FIA) in infants. METHODS Data of patients aged <1 year who presented to our department with perianal abscess (PA) between January 2006 and February 2010 were retrospectively reviewed. Our standard initial treatment for PA was incision and drainage. Patients with systemic diseases and inflammatory bowel diseases were excluded. RESULTS Ninety-five patients were treated for PA and/or FIA during the 5-year period, and follow-up data were available for 90 patients. The mean follow-up duration in these patients was 49.8 ± 11.4 months, and mean age at presentation was 3.1 ± 2.7 months. Of the 90 patients, 36 (40%) developed FIA (39 lesions) and underwent seton placement. The condition healed in a mean period of 6.3 ± 4.0 weeks after the placement of a cutting seton. Healing of the fistula was achieved in 35 (97.2%) of 36 patients after the initial seton procedure, and one patient who showed recurrence underwent a second seton placement, resulting in successful healing of the FIA after 5 weeks. CONCLUSIONS The long-term success of seton placement indicates that this procedure should be a treatment option for FIA in infants.
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Affiliation(s)
- Mikiya Inoue
- Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan
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26
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Surgical treatment of perianal abscess and fistula-in-ano in childhood, with emphasis in children older than 2 years. J Pediatr Surg 2012; 47:2096-100. [PMID: 23164005 DOI: 10.1016/j.jpedsurg.2012.06.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 05/18/2012] [Accepted: 06/25/2012] [Indexed: 11/22/2022]
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.
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Kawahara H, Nakai H, Yoneda A, Kubota A. Management of perianal abscess with hainosankyuto in neonates and young infants. Pediatr Int 2011; 53:892-6. [PMID: 21575105 DOI: 10.1111/j.1442-200x.2011.03395.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Perianal abscess (PA) is a common condition acquired in infancy, yet its treatment method remains controversial. We reviewed the outcome of neonates and young infants with PA who were treated with the traditional Japanese medicine, hainosankyuto (TJ-122). METHODS Fifteen male infants with PA under the age of 3 months were reviewed. The median age of infants at disease onset was 33 days (range, 18-88 days) and the median bodyweight was 4.1 kg (range, 2.5-6.4 kg). TJ-122 was administered at a dose of 0.20 g/kg/day (n= 13) or 0.25 g/kg/day (n= 2) orally in two or three divided doses before meals. Antibiotics were not used in any of the patients. RESULTS Of the 15 patients, 14 were cured and had no recurrence, with a median TJ-122 administration of 28 days (range, 14-117 days). Eight patients were cured within 28 days (53%) and 12 were cured within 60 days (80%). One patient, who was later diagnosed with growth hormone deficiency, showed incomplete healing of PA with intermittent pus discharge and recurrence. The patient was cured by 1 year of age following repeated administration of TJ-122 and juzentaihoto (TJ-48). CONCLUSION Medical management with TJ-122 was effective in most neonates and young infants with PA. It appears prudent to manage these patients with hainosankyuto before resorting to surgical intervention.
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Affiliation(s)
- Hisayoshi Kawahara
- Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
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Abstract
PURPOSE The aims of this study are to evaluate the clinical characteristics of perianal abscess and fistula-in-ano in children, and to assess our experience in treatment, and to identify factors that affected the clinical outcomes. METHODS A retrospective review of children with perianal abscess and fistula-in-ano was carried out in a tertiary care children's hospital from January 2005 to December 2010. Demographic information of the patients, localization of the lesions, treatment procedures, microbial organisms in pus, usage of antibiotics, abscess recurrence, development of fistula-in-ano, and duration of symptoms were recorded. Patients with systemic diseases and inflammatory bowel diseases were excluded from the study. RESULTS A total of 158 children (146 males, 12 females) treated for perianal abscess and fistula-in-ano with a median age of 7.2 months (ranging 16 days to 18 years) were eligible for the study. Initial examination of the 136 patients revealed perianal abscess and 22 patients with fistula-in-ano. Primary treatment was incision and drainage (I/D) for the fluctuating perianal abscess (73.5%), and local care for the spontaneously (S/D) drained abscess (26.5%) with or without antibiotic therapy. Patients were divided into two groups according to age distribution, 98 of the patients were younger than 12 months, and 60 were older than 12 months of age. There was no significant difference in sex distribution, localization of the lesions, treatment procedures, recurrence of abscess and fistula-in-ano formation between the two age groups (p > 0.05). Recurrence rates (27% in I/D and 30.6% in S/D, p > 0.05) and development of fistula-in-ano (20% in I/D and 27.8 in S/D, p > 0.05) were not significant I/D and S/D groups. Kind of the microorganisms in pus swaps did not effect the fistula-in-ano formation. Usage of antibiotics significantly reduced the development of fistula-in-ano (p = 0.001), but did not effect the recurrence of perianal abscess (p > 0.05). The mean follow-up period was 10.6 ± 8.6 months. While the 9 of the overall 52 fistula-in-ano (22 initial, 30 after abscess treatment) were resolved spontaneously, 43 of the remaining needed surgical intervention (fistulotomy/fistulectomy). CONCLUSIONS Although management of perianal abscess is still controversial, simple drainage of the perianal abscess with additional antibiotic therapy reduces the development of fistula-in-ano. Fistula-in-ano within children has a chance of spontaneous resolution thus the immediate surgical intervention should be avoided.
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Chang HK, Ryu JG, Oh JT. Clinical characteristics and treatment of perianal abscess and fistula-in-ano in infants. J Pediatr Surg 2010; 45:1832-6. [PMID: 20850628 DOI: 10.1016/j.jpedsurg.2010.03.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2010] [Revised: 03/16/2010] [Accepted: 03/20/2010] [Indexed: 11/24/2022]
Abstract
PURPOSE The aims of this study were to evaluate the clinical characteristics of perianal abscess and fistula-in-ano in infants and to identify factors that affected the clinical outcomes. METHOD The authors retrospectively reviewed the clinical data of 112 infants who were treated for perianal abscess and fistula-in-ano by a single pediatric surgeon from January 2006 to December 2008. RESULTS All patients were male and the mean age of infants presented to our hospital was 6.0 ± 4.5 months. One hundred one patients (90.2%) had 1 or 2 perianal lesions, and 76 (67.9%) had lesions at the 3 and/or 9-o'clock directions. The use of oral antibiotics did not improve or aggravate the lesions in 29 of 37 cases. Ninety-seven patients (86.6%) were cured by conservative treatment with a mean duration of 5.2 ± 3.9 months from the onset of the disease to the cure. The mean age of curing was 9.0 ± 4.9 months. Feeding formula change showed improvement of stooling in 38 (62.3%) of 61 patients but did not affect the duration of conservative treatment. Multiple linear analysis revealed that the presence of multiple lesions was a significant independent variable (P = .001) for the duration of conservative treatment, but age of the onset and location of the lesion were not. Twelve patients (10.7%) underwent fistulectomy at a mean age of 15.0 ± 5.1 months. None of the patients had recurrences after operation for the mean follow-up period of 23.7 ± 11.7 months. CONCLUSION Conservative treatment of perianal abscess and fistula-in-ano has an excellent outcome and could be the first choice of treatment of these diseases.
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Affiliation(s)
- Hye Kyung Chang
- Department of Pediatric Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul 120-752, South Korea
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Ezer SS, Oğuzkurt P, Ince E, Hiçsönmez A. Perianal abscess and fistula-in-ano in children: aetiology, management and outcome. J Paediatr Child Health 2010; 46:92-5. [PMID: 20105258 DOI: 10.1111/j.1440-1754.2009.01644.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM We aimed to assess our experience in treatment and outcome of perianal abscess and/or fistula-in-ano in children. METHOD The patients who were treated for perianal abscess and/or fistula-in-ano from January 2000 to December 2005 were included. Age, sex, duration of symptoms, number and site of the perianal abscess and/or fistula-in-ano, treatment modality and recurrences were recorded. RESULTS The study consisted of 39 patients (36 boys) with a mean age of 29 +/- 49.1 months. At first examination the diagnosis was perianal abscess in 20 patients, perianal abscess with fistula in five patients and fistula-in-ano in 14 patients. No patients had an underlying illness. The primary local treatment of perianal abscess with or without fistula was incision and drainage (with or without antibiotic therapy) in 21 patients, and local care with antibiotic therapy was given to four patients. Of 20 patients with perianal abscess, 17 developed fistula-in-ano and three healed. One patient in the perianal abscess group who developed fistula-in-ano and two patients in the fistula group were lost to follow-up. Thirty-three patients with fistula-in-ano underwent surgical treatment either through a fistulotomy or through a fistulectomy. Five (15.1%) patients who experienced recurrent fistula-in-ano underwent fistulotomy were completely cured after the second operation. CONCLUSION Treatment of a perianal abscess either through incision and drainage with antibiotics or through antibiotics alone resulted in a high rate (85%) of fistula formation. Fistula-in-ano can be treated either by fistulotomy or by fistulectomy, both of which are associated with a reasonable chance of recurrence of fistula-in-ano formation. We obtained good results in our patients through surgical approach (fistulotomy or fistulectomy), for fistula-in-ano formed following treatment of perianal abscess.
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Affiliation(s)
- Semire Serin Ezer
- Department of Pediatric Surgery, Başkent University Faculty of Medicine, Adana, Turkey
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Abstract
INTRODUCTION Fistula in ano is a common malady in infancy. However, relatively little literature is devoted to it. Our aim was to describe the natural history and identify predictors of which children will ultimately recur. METHODS A retrospective review of patients less than 3 years old undergoing anal fistulotomy was performed between May 2002 and November 2007 at a tertiary children's hospital. Demographics, preoperative, operative, and postoperative characteristics were collected in each group and evaluated by biostatistical analysis. P values <0.05 were considered significant. RESULTS A total of 92 children undergoing anal fistulotomy were identified. The median age was 6 months. Twelve children (13%) had recurrences and two of the 12 had multiple recurrences. Children who had recurrences were older (12.9 vs. 7.5 months, P < 0.05) and were more likely to have a previous abscess (20 vs. 6%, P < 0.05). In addition, children with recurrences had pus noted at the time of surgery more than children who did not recur (23 vs. 8%, respectively, P < 0.05). There were no major complications. CONCLUSIONS Fistula in ano in infants is a relatively benign process with most children having no serious sequelae. However, a not insignificant portion (13%) of children developed recurrences. Older children who developed fistulas were more likely to have a recurrence than younger, and children who had previous episodes of perianal abscess or pus noted at the time of surgery were more likely to recur.
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Affiliation(s)
- Nathan M Novotny
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr. EH 202, Indianapolis, IN 46202, USA.
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Christison-Lagay ER, Hall JF, Wales PW, Bailey K, Terluk A, Goldstein AM, Ein SH, Masiakos PT. Nonoperative management of perianal abscess in infants is associated with decreased risk for fistula formation. Pediatrics 2007; 120:e548-52. [PMID: 17682038 DOI: 10.1542/peds.2006-3092] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We sought to determine the frequency of progression in infants of perianal abscess with and without surgical drainage to fistula in ano to optimize a treatment plan for these children. METHODS A retrospective cohort study was conducted of all patients who were < or = 1 year of age and presented with perianal abscess to 2 pediatric tertiary care institutions during a 10-year period (January 1995 to February 2005, inclusive). Patients were divided into those who underwent surgical drainage and those who did not, and the rate of subsequent fistula formation was determined. RESULTS Of 165 children initially identified, follow-up was available for 140. Ninety-four percent of children were male. Mean age was 4.2 +/- 3.1 months. Of the 140 patients, 83 abscesses were drained and 57 were not drained. Of patients who underwent surgical drainage, 50 developed a fistula, whereas of those who did not undergo drainage only 9 developed a fistula. Synchronous administration of antibiotics (intravenous or oral) used in 57 of 58 patients from 1 institution was associated with an even greater decrease in fistula formation (12.5%) in the undrained population. CONCLUSIONS Perianal abscess formation in infants who are younger than 12 months is a separate entity from abscess formation in older age groups. In this largest study to date, a combined center series of patients who presented to 2 academic pediatric hospitals with infantile perianal abscess, local hygiene and systemic antibiotics without surgical drainage minimized formation of fistula in ano.
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Affiliation(s)
- Emily R Christison-Lagay
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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Ikeda T, Inoue M, Sugitou K, Hagiwara N, Koshinaga T, Kusafuka T. Treatment of fistula-in-ano in infants with a seton. J Pediatr Surg 2007; 42:1095-7. [PMID: 17560227 DOI: 10.1016/j.jpedsurg.2007.01.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Anal fistula in infants is a common disease. Although many are recovered by conventional treatment, there are some patients who are not repaired easily. We performed the seton method to an anal fistula and report the good result that we obtained.
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Affiliation(s)
- Taro Ikeda
- Division of Pediatric Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo 173-8610, Japan.
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Meyer T, Weininger M, Höcht B. [Perianal abscess and anal fistula in infancy and childhood. A congenital etiology?]. Chirurg 2007; 77:1027-32. [PMID: 16947036 DOI: 10.1007/s00104-006-1223-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Perianal abscess and anal fistula in childhood are commonly treated in the same way as abscess and fistula in adults. We questioned whether they represent a cryptoglandular infection, as in adults, or two different diseases with the same symptoms. MATERIALS AND METHODS We retrospectively analyzed all medical records of 80 children (seven male, 73 female) who underwent surgical treatment for primary perianal abscess or primary anal fistula during a 10-year period. The records were analyzed concerning age at appearance of lesion, sex, diagnosis (fistula and/or abscess), and anatomic localization of the lesion. RESULTS Of all the children, 67.5% were treated during their 1st year of life and another 10% during their 2nd year (group 1: 77.5%, n=62). Only 22.5% were 3 or older (group 2, n=18). Group 1 contained significantly more male infants (m:f 30:1). However, much more balanced sex distribution was detected in group 2 (m:f 2.6:1), similarly to adults. Analyzing anatomic localization, a second important difference could be found: in contrast to group 2, almost two thirds of all anal fistulas/abscesses in group 1 were localized horizontally between 3:00 and 9:00 o'clock in crown-rump position. CONCLUSIONS Divergences in preference of age, sex, and localization suggest a congenital etiology for anal fistulas and perianal abscesses in children.
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Affiliation(s)
- T Meyer
- Abteilung für Kinderchirurgie Chirurgische Universitätsklinik und Poliklinik I, Zentrum Operative Medizin, Bayerische Julius-Maximilians-Universität, Oberdürrbacher Strasse 6, 97080 Würzburg, Deutschland.
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Abstract
Children, just as adults, have a variety of common anorectal problems that can be quite bothersome. The presentation of these problems may be age-specific. Abscesses, fistulas, and fissures appear more commonly in infants and young children, whereas hemorrhoids and pilonidal disease are more common in teens and young adults. Fissures often can be treated medically but may require surgical treatment with lateral internal sphincterotomy. Abscesses and fistulas are common in infant males, especially robust infants who are breastfed. They may resolve with medical therapy but anal fistulotomy is not infrequently required. Hemorrhoids are rare in young children but may be an issue for teenagers. Acute symptomatic lesions may require excision if local measures cannot control the symptoms. Finally, pilonidal disease is a difficult problem for the patient and the surgeon. Persistently symptomatic lesions demand some type of surgical treatment but wound healing is poor in the intergluteal cleft region. More extensive procedures requiring the transfer of fasciocutaneous flaps may be necessary to provide definitive relief. Anorectal problems in infants and children are frequent and bothersome. Although most are not associated with tremendous morbidity, they can lead to much patient and parent anxiety as well as frequent medical consultation until the problem is successfully treated or resolves.
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Affiliation(s)
- Thomas Stites
- Department of Surgery, University of Wisconsin--Madison, Madison, Wisconsin 53792, USA
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Gupta PJ. Multiple anal fistulae in a 5-year-old boy. SURGICAL PRACTICE 2006. [DOI: 10.1111/j.1744-1633.2006.00303.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Serour F, Gorenstein A. Characteristics of perianal abscess and fistula-in-ano in healthy children. World J Surg 2006; 30:467-72. [PMID: 16467979 DOI: 10.1007/s00268-005-0415-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Probably because of the low frequency, perianal abscess (PA) and fistula-in-ano (FIA) in children older than 2 years have not been investigated except in those with a predisposing condition such as Crohn's disease. This study aims to summarize our experience about the characteristics and treatment of PA and FIA in healthy children. METHODS The charts of all children older than 24 months of age treated for PA and/or FIA from 1990 to 2003 were reviewed. RESULTS We found 40 patients, 37 of them boys (92.5%), ranging from 2 to 14 years of age (average: 7.19 years). At the first examination, the diagnosis was PA in 36 patients (mean age: 6.8 years; range: 2.3-13 years), and FIA in 4 patients (mean age: 10.8 years; range: 6-14 years). The primary local treatment of PA was drainage (needle aspiration in 26 patients, and incision and drainage in 4 patients) and local care in 6 patients. All patients received antibiotics. Overall, 29 children (80.6%) had primary cure of the abscess. Evolution included recurrent abscess in 3 patients (8.3%) and FIA in 4 patients (11.1%). Crohn's disease was diagnosed in only one boy with an abscess of long duration. No patient developed a new PA in another location or a recurrent FIA. Four male patients aged 6 to 14 years (range: 7.1 years) had a FIA of long duration. One patient underwent a fistulectomy. Crohn's disease was found in three other children and treated conservatively. CONCLUSION Drainage of PA by needle aspiration associated with antibiotics is effective in children older than 2 years of age with a low rate of evolution toward FIA. Associated pathology must be ruled out in children with FIA.
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Affiliation(s)
- Francis Serour
- Department of Pediatric Surgery, The Edith Wolfson Medical Center, Halokhamim Street 62, P.O. Box 5, Holon, 58100, Israel.
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Abstract
PURPOSE The features of perianal abscess and fistula-in-ano in infants are different from those of older children, and there is controversy regarding their treatment. The aim of this study was to assess the efficacy of various methods used for their management. METHODS A retrospective analysis of the records was conducted for all infants younger than 24 months of age treated for perianal abscess, fistula-in-ano, or both from 1990 to 2002. RESULTS The study included 98 infants. Perianal abscess was found in 77 patients (75 males), and fistula-in-ano in 21. No infant had an underlying illness. Drainage was performed by needle aspiration in 47 patients and by incision and drainage in 5. Following drainage, 43 patients received antibiotics. Altogether, 6 infants were treated with antibiotics alone and 19 with local care alone. Twenty-eight boys (36.4 percent) had an evolution toward fistula-in-ano. Patients who received antibiotics following drainage were less likely to develop fistula-in-ano than were patients who underwent a drainage procedure alone (27.9 percent vs. 66.7 percent, P < 0.05). All patients with fistula-in-ano were male and had been previously treated for perianal abscess (21 patients elsewhere and 28 in our department). Spontaneous cure of fistula-in-ano occurred in 42.9 percent of them (average 3.2 months), and 57.1 percent underwent fistulectomy for persistent fistula-in-ano. Cryptotomy was added when an involved crypt was found (11 patients, 39.3 percent). No recurrence of fistula-in-ano was noted after fistulectomy. CONCLUSIONS Local treatment for perianal abscess during the early stage and drainage by needle aspiration during the progressive stage are effective. Antibiotics may be considered for patients undergoing drainage of perianal abscess. Fistula-in-ano can be managed conservatively for one to three months. For a persisting fistula, fistulectomy with cryptotomy (when abnormal anal crypts are found) is the preferred treatment.
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Affiliation(s)
- Francis Serour
- Department of Pediatric Surgery, The Edith Wolfson Medical Center, Halokhamim Street 62, 58100 Holon, Israel.
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Abstract
AIM: To summarize the operative experience of the transanal approach in acquired rectovestibular fistula repair.
METHODS: Ninety-six cases of acquired rectovestibular fistula in young females were analyzed retrospectively. The etiology and operative procedure were discussed. Operative essential points were, the patient was laid in prone frog position, with the knees and hips flexed at 90o; the perineum was elevated; and the anal opening was exposed. Four stay sutures were applied to the margin of the fistular orifice in the anal opening at points 3, 6, 9 and 12 o’clock. A circular incision of mucosa surrounding the stay sutures was made. The fistula was dissected from its anal opening to its vestibular opening. The wound of vestibule was sutured, and the rectoanal wound was then sutured transversely.
RESULTS: All the 96 patients recovered uneventfully from operation with a successful rate of 93.75%.
CONCLUSION: The transanal approach in the treatment of the acquired rectovestibular fistula is a simple and feasible technique.
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Affiliation(s)
- Ya-Jun Chen
- Beijing Children's Hospital, Capital University of Medical Sciences, Beijing 100045, China.
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Ohya T, Usui Y, Okamoto K, Inoue Y, Arii S, Iwai T. Management for fistula-in-ano with Ginseng and Tang-kuei Ten Combination. Pediatr Int 2004; 46:72-6. [PMID: 15043669 DOI: 10.1111/j.1442-200x.2004..x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Non-operative management for patients with fistula-in-ano in infancy using a traditional herbal medicine Ginseng and Tang-kuei Ten Combination (GTTC) is described. METHODS A total of 22 patients with peri-anal abscess or fistula-in-ano were treated with GTTC. Eighteen patients showed no improvement using the conventional non-operative management (frequent curettage of abscess cavity), after which administration of GTTC was commenced. The other four patients received GTTC from the beginning of their treatment. A dose of 0.1-0.2 g/kg of GTTC was given orally twice a day. The period between onset of peri-anal abscess and the commencement of GTTC (pre-GTTC period) was compared to the period until remission after administration of GTTC (post-GTTC period). The relationship between the GTTC dose, age at onset of peri-anal abscess, post-GTTC period, and relapse rates were investigated. RESULTS Twenty-one patients reached remission, but a 4-year-old boy failed to reach remission and he required fistelectomy. Pre-GTTC periods were from 11 days to 3 years (median 50 days) and statistically longer than post-GTTC periods (4-65 days, median 7 days). There was a reverse correlation between the age at onset of peri-anal abscess and post-GTTC period (r = -044, P < 0.05). There was no statistical correlation between the dose of GTTC and post-GTTC period. Five patients showed relapse after discontinuing GTTC, all of them could be resolved with augmentation of the dose. The onset of peri-anal abscess in patients who relapsed were all < 3 months of age. CONCLUSION Ginseng and Tang-kuei Ten Combination seemed to accelerate the recovery of patients with fistula-in-ano in infancy.
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Affiliation(s)
- Toshiki Ohya
- Department of Surgery and Pediatric Surgery, Tokyo Medical & Dental University, Tokyo, Japan.
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Burd RS, Price MR. Evaluation and initial management of miscellaneous pediatric surgical problems. Pediatr Ann 2001; 30:752-9. [PMID: 11766204 DOI: 10.3928/0090-4481-20011201-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- R S Burd
- Bristol-Myers Squibb Children's Hospital, Robert Wood Johnson University Hospital, Department of Surgery, Division of Pediatric Surgery, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Abstract
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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Affiliation(s)
- J T Oh
- Department of Pediatric Surgery, Yonsei University College of Medicine, Seoul, Korea
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Abstract
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.
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Affiliation(s)
- N G Rosen
- Division of Pediatric Surgery, Schneider Children's Hospital, New Hyde Park, New York 11040, USA
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Dermatologic Proctology. Dermatology 2000. [DOI: 10.1007/978-3-642-97931-6_67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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