Perianal abscess and fistula-in-ano in children – evaluation of treatment’s efficacy. Are we able to avoid the recurrence?

Abstract

AIM Perianal abscess and fistula-in-ano are common findings in infants and children. The perianal abscess is usually a manifestation of the fistula-in-ano. Experience of our center indicates a general lack of knowledge of the abscess’s origin therefore it is usually treated by incision and drainage which leads to numerous recurrence. We aimed to present the optimal management of the fistula-in-ano and perianal abscess to lower or even eliminate recurrences. METHOD The retrospective study consisted of 24 infants treated in our center with perianal abscess from 2013 to 2015. The patients were divided into two groups: group I (50%) was primary treated in our center, group II had prior surgical interventions in other hospitals. Fistula-in-ano was intraoperatively identified in all patients (100%) and fistulotomy was performed. RESULTS No recurrence of the perianal abscess or fetal incontinence were observed in any patient. In the group II, the ailment was associated with severe inflammation, some patients underwent an additional surgical intervention such as incision and drainage of the extensive buttock’s abscess; the patients required longer antibiotic therapy and longer hospitalization. CONCLUSION Low-invasive approach (hip-bath, antibiotic therapy, puncture or incision and drainage of the abscess) seems to be tempting due to its simplicity and no need of general anesthesia but it is associated with high recurrence rate. Fistulotomy and fistulectomy, which are slightly more invasive procedures, significantly lower the recurrence rate of fistula-in-ano and perianal abscess.