Surgical treatment of perianal abscess and fistula-in-ano in neonates and infants

Ignat’ev V.V.

Sevastopol City Hospital No. 5 — Center for Maternal and Child Health Protection

ORCID: 0009-0002-4844-9571

Shramko P.V.

Sevastopol City Hospital No. 5 — Center for Maternal and Child Health Protection

ORCID: 0009-0005-2659-8615

Muraviev A.V.

Sevastopol City Hospital No. 5 — Center for Maternal and Child Health Protection

ORCID: 0009-0005-2659-8615

Garapov T.A.

Sevastopol City Hospital No. 5 — Center for Maternal and Child Health Protection;
Sevastopol City Pirogov Hospital No. 1

ORCID: 0009-0002-9386-7115

Tishukov M.Yu.

Vernadsky Crimean Federal University

ORCID: 0000-0002-7220-960X

Surgical treatment of perianal abscess and fistula-in-ano in neonates and infants

Authors:

Ignat’ev V.V., Shramko P.V., Muraviev A.V., Garapov T.A., Tishukov M.Yu.

More about the authors

Journal: Pirogov Russian Journal of Surgery. 2024;(11): 46‑53

DOI: 10.17116/hirurgia202411146

Downloaded: 6

Contact the author

Table of contents

To cite this article:

Ignat’ev VV, Shramko PV, Muraviev AV, Garapov TA, Tishukov MYu. Surgical treatment of perianal abscess and fistula-in-ano in neonates and infants. Pirogov Russian Journal of Surgery. 2024;(11):46‑53. (In Russ.)
https://doi.org/10.17116/hirurgia202411146

Подписка 2025 (Pirogov Russian Journal of Surgery)

Close metadata

OBJECTIVE

To compare the incision and drainage of perianal abscess (ID) without fistulotomy with Gabriel procedure (GP) in neonates and infants with perianal abscess and fistula-in-ano.

MATERIAL AND METHODS

A single-center retrospective comparative study included neonates and infants aged 1—12 months with first occuring perianal abscess and fistula-in-ano. Postoperative follow-up was 1 year. Abscess with fistula was confirmed in all patients.

RESULTS

The study included 31 boys (13 ones in the ID group, and 18 ones in the GP group). Clinical characteristics were similar in both groups. The cure rate in the OG group (100%, 18/18) was significantly higher than in the ID group (54%, 7/13; p=0.002). Abscess recurrence was significantly less common in the OG group (p=0.002). No fecal incontinence was observed in any patient. We analyzed the factors affecting the incidence of perianal abscess and fistula-in-ano recurrence using the odds ratio and 95% confidence interval (CI). There was no correlation between recurrence rate and positive bacteriological examination of postoperative wound as well as type of feeding (OR 0.5; 95% CI 0.07 — 3.55; p=0.24, and OR 0.53; 95% CI 0.058 — 4.912; p=0.15, respectively).

CONCLUSION

Recurrence rate is significantly lower after GP for perianal abscess and fistula-in-ano.

Keywords:

neonates

infants

perianal abscess

fistula-in-ano

incision and drainage

fistulectomy

abscess recurrence

Authors:

Ignat’ev V.V.

Sevastopol City Hospital No. 5 — Center for Maternal and Child Health Protection

ORCID: 0009-0002-4844-9571

Shramko P.V.

Sevastopol City Hospital No. 5 — Center for Maternal and Child Health Protection

ORCID: 0009-0005-2659-8615

Muraviev A.V.

Sevastopol City Hospital No. 5 — Center for Maternal and Child Health Protection

ORCID: 0009-0005-2659-8615

Garapov T.A.

Sevastopol City Hospital No. 5 — Center for Maternal and Child Health Protection;
Sevastopol City Pirogov Hospital No. 1

ORCID: 0009-0002-9386-7115

Tishukov M.Yu.

Vernadsky Crimean Federal University

ORCID: 0000-0002-7220-960X

Received:

11.02.2024

Accepted:

20.03.2024

List of references:

Al-Salem AH, Laing W, Talwalker V. Fistula-in-ano in infancy and childhood. Journal of Pediatric Surgery. 1994;29:436-438. https://doi.org/10.1016/0022-3468(94)90587-8
Afşarlar CE, Karaman A, Tanır G, Karaman I, Yılmaz E, Erdoğan D, Maden HA, Cavuşoğlu YH, Ozgüner IF. Perianal abscess and fistula-in-ano in children: clinical characteristic, management and outcome. Pediatric Surgery International. 2011;27:1063-1068. https://doi.org/10.1007/s00383-011-2956-7
Abercrombie JF, George BD. Perianal abscess in children. Annals of the Royal College of Surgeons of England. 1992;74:385-386.
Watanabe Y, Todani T, Yamamoto S. Conservative management of fistula in ano in infants. Pediatric Surgery International. 1998;13:274-276. https://doi.org/10.1007/s003830050315
Samuk I, Avinadav E, Barak U, Seguier E, Steiner Z, Freud E. Perianal abscess in infants: Amenable to conservative treatment in selected cases. Pediatrics International. 2019;61:1146-1150. https://doi.org/10.1111/ped.13996
Rosen NG, Gibbs DL, Soffer SZ, Hong A, Sher M, Peña A. The nonoperative management of fistula-in-ano. Journal of Pediatric Surgery. 2000;35:938-939. https://doi.org/10.1053/jpsu.2000.6931
Gong Z, Han M, Wu Y, Huang X, Xu W-J, Lv Z. Treatment of First-Time Perianal Abscess in Childhood, Balance Recurrence and Fistula Formation Rate with Medical Intervention. European Journal of Pediatric Surgery. 2018;28:373-377. https://doi.org/10.1055/s-0037-1603092
Gosemann J-H, Lacher M. Perianal Abscesses and Fistulas in Infants and Children. European Journal of Pediatric Surgery. 2020;30:386-390. https://doi.org/10.1055/s-0040-1716726
Ding W, Sun Y-R, Wu Z-J. Treatment of Perianal Abscess and Fistula in Infants and Young Children: From Basic Etiology to Clinical Features. The American Surgeon. 2021;87:927-932. https://doi.org/10.1177/0003134820954829
Buddicom E, Jamieson A, Beasley S, King S. Perianal abscess in children: aiming for optimal management. ANZ Journal of Surgery. 2012;82:60-62. https://doi.org/10.1111/j.1445-2197.2011.05941.x
Bałaż K, Trypens A, Polnik D, Pankowska-Woźniak K, Kaliciński P. Perianal abscess and fistula-in-ano in children — evaluation of treatment’s efficacy. Are we able to avoid the recurrence? Polski Przeglad Chirurgiczny. 2020;92:1-5. https://doi.org/10.5604/01.3001.0013.8158
Juth Karlsson A, Salö M, Stenström P. Outcomes of Various Interventions for First-Time Perianal Abscesses in Children. BioMed Research International. 2016;2016:1-6. https://doi.org/10.1155/2016/9712854
Murthi G, Okoye B, Spicer R, Cusick E, Noblett H. Perianal abscess in childhood. Pediatric Surgery International. 2002;18:689-691. https://doi.org/10.1007/s00383-002-0761-z
Tan Tanny SP, Wijekoon N, Nataraja RM, Lynch A, Pacilli M. Surgical management of perianal abscess in neonates and infants. ANZ Journal of Surgery. 2020;90:1034-1036. https://doi.org/10.1111/ans.15801
Gabriel WB. Skin Grafts for Fistulae. Proceedings of the Royal Society of Medicine. 1927;20:1278-1279.
Cogen AL, Nizet V, Gallo RL. Skin microbiota: a source of disease or defence? British Journal of Dermatology. 2008;158:442-455. https://doi.org/10.1111/j.1365-2133.2008.08437.x
Todar KG. Todar’s Online textbook of bacteriology. n.d.
Lozovoy VM, Botabayeva AS, Tastanbekova ZU, Shakeyeva AR. A method for the treatment of acute subcutaneous anal abscess in children. Valeology. 2019;(1):135-141. (In Russ.).
Kuzmin AI, Munin AG, Barskaya MA, Terekhina MI, Zavyalkin VA, Shifrin GI. Peculiarities of diagnostics and treatment of paraproctitis in children. Detskaja Hirurgija. 2020;24:29-34. (In Russ.). https://doi.org/10.18821/1560-9510-2020-24-1-29-34
Oh J-T, Han A, Han SJ, Choi SH, Hwang EH. Fistula-in-ano in infants: Is nonoperative management effective? Journal of Pediatric Surgery. 2001;36:1367-1369. https://doi.org/10.1053/jpsu.2001.26372
Yin W, Li L, Su L, Wang S. Incision and Drainage With Primary Fistulotomy of Perianal Abscess Is Safe and Effective in Neonates: A Long-Term Follow-Up Study. Frontiers in Pediatrics. 2022;10:862317. https://doi.org/10.3389/fped.2022.862317
Ali Gafar AMA. Fistulotomy versus fistulectomy as a treatment for low anal fistula in infants: a comparative study. Annals of Pediatric Surgery. 2013;9:103-107. https://doi.org/10.1097/01.XPS.0000430519.91184.f6
Emile SH, Elfeki H, Abdelnaby M. A systematic review of the management of anal fistula in infants. Techniques in Coloproctology. 2016;20:735-744. https://doi.org/10.1007/s10151-016-1536-1

Close metadata