The nonoperative management of fistula-in-ano

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 p erianal fistula follow a self-limited course the authors decided to determi ne if this observation was accurate. Methods: A conservative approach to perianal abscess and fistula was used p rospectively in 18 male infants. Abscesses were to be drained only if the b aby 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 develop ed in 14 patients (77%). All fistulas healed without operation. Four patien ts had abscesses drained Car discomfort (n = 3) or fever (n = 1). No patien t required antibiotics. Mean duration of symptoms was 6 +/- 4 months. Four patients in whom fistulas did not form healed after incision (n = 3) or spo ntaneous drainage (n = 1). All patients currently are asymptomatic. Conclusions: In healthy neonates, perianal abscess and fistula are self-lim ited conditions rarely requiring surgical drainage and not requiring antibi otics. The conservative management of perianal abscess and fistula in healt hy infants appears to be safe and effective. Copyright (C) 2000 by W.B. Sau nders Company.