A systematic review of the management of anal fistula in infants

Abstract

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.

Perianal Abscesses and Fistulas in Infants and Children

“…However, current evidence suggests that PA and FIA in infants are generally self-limiting conditions and conservative, nonoperative strategies should be the first line treatment in this specific age group, whereas surgery should preferentially be reserved for patients who failed conservative management or complex fistulas. 18…”

“…Among the patients who were treated surgically, 29% were reported to have FIA in the further course. 18 I/D of PA remains the treatment of choice in many centers since most surgeons claim faster pain relief and wound healing after I/D compared with spontaneous drainage (S/ D). 4,10,19 To date, these hypotheses have not been confirmed in the pediatric population based on prospective data.…”

“…The remaining 24 patients underwent surgery after failure of nonoperative management. 18 Although several authors advocate conservative approaches for PA and FIA, the majority of surgeons obviously considers surgery as the primary treatment option. However, based on the systematic review, Emile et al recommended conservative treatment in all infants as a first line therapy due to its high success rate and excellent safety profile.…”

“…Fistulectomy would better be reserved for high and complex fistulae when recurrence is anticipated. 18 The main drawback of these data are the lack of a long-term follow-up in the majority of studies. This would be required to specify incidence of long-term morbidities, such as incontinence that has been identified as a relevant complication after seton placement in adult FIA.…”

“…This would be required to specify incidence of long-term morbidities, such as incontinence that has been identified as a relevant complication after seton placement in adult FIA. 18,20 Children >1 Year Only few authors focused on PA and FIA in children older than 12 months, as more than 95% of pediatric FIA are reported in infants. 18 A retrospective series including 96 patients with PA and FIA older than 2 years was analyzed by Charalampopoulos et al in 2012.…”