Analysis of treatment methods and outcomes for perianal abscess (PA) and fistula in ano (FIA) in infants

Introduction. Perianal abscess (PA) is a relatively common condition in children and occurs in 0.5 to 4.3% of the infant population. In the majority of cases, it is associated with fistula in ano (FIA). Surgical treatment of FIA includes fistulectomy, fistulotomy or, rarely, cryptotomy. Aim. The aim of the study is to perform a retrospective analysis of treatment methods and outcomes for PA and FIA in infants at the Department of Paediatric Surgery and Urology of the Regional Specialised Children’s Hospital in Olsztyn, Poland, in 2014-2019. Material and methods. From January 2014 to December 2019, 44 infants with diagnosed PA and FIA were treated. The majority of patients were boys: 41 (93%) and only 3 (7%) were girls. For PA, three different treatment methods were used: incision and drainage, fistulotomy or fistulectomy. Results. Out of 44 treated infants with diagnosed PA and FIA, 29 were treated only by incision and drainage. Among them, 19 were cured. FIA was identified in 9 patients and fistulectomy or fistulotomy was performed. In this group, there was 1 recurrence, which was retreated with fistulectomy and cured. In 6 patients, PA drained spontaneously; in 3 of them there was recurrence and FIA was diagnosed during another hospital stay. There were 7 fistulotomies and 14 fistulectomies performed and their efficacy was 100 vs 93%, respectively. Conclusions. Fistulotomy is the most effective and safest method of FIA treatment in infants. In every case of perianal abscess diagnosis, a fistula in ano should be looked for.