Fistula-in-ano in infants: Is nonoperative management effective?

Purpose: Recently, a number of studies have reported positive results from the nonoperative management of fistulain-ano in infancy, although it has no t 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 opera tive management for fistula-in-ano or perianal abscess between January 1991 and July 2000. Eighteen patients displayed an onset of symptoms at less th an 1 year of age and a duration of symptoms longer than 12 months, The auth ors 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 showe d 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 fistul a-in-ano in infants include the avoidance of general anesthesia and surgica l intervention, the lesions cannot be cured by a period of conservation, Su rgical management is more effective in respect to the time factor. J Pediat r Surg 36:1367-1369. Copyright (C) 2001 by W.B. Saunders Company.