The nonoperative management of fistula-in-ano.
OBJECTIVE
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 perianal fistula follow a self-limited course the authors decided to determine if this observation was accurate.


METHODS
A conservative approach to perianal abscess and fistula was used prospectively in 18 male infants. Abscesses were to be drained only if the baby 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 developed in 14 patients (77%). All fistulas healed without operation. Four patients had abscesses drained for discomfort (n = 3) or fever (n = 1). No patient required antibiotics. Mean duration of symptoms was 6 +/- 4 months. Four patients in whom fistulas did not form healed after incision (n = 3) or spontaneous drainage (n = 1). All patients currently are asymptomatic.


CONCLUSIONS
In healthy neonates, perianal abscess and fistula are self-limited conditions rarely requiring surgical drainage and not requiring antibiotics. The conservative management of perianal abscess and fistula in healthy infants appears to be safe and effective.
Rosen
N G
NG
Division of Pediatric Surgery, Schneider Children's Hospital, New Hyde Park, New York 11040, USA.
Gibbs
D L
DL
Soffer
S Z
SZ
Hong
A
A
Sher
M
M
Peña
A
A
D000038:Abscess / Q000628:therapy; D001004:Anus Diseases / Q000628:therapy; D004322:Drainage; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012003:Rectal Fistula / Q000628:therapy*; D012008:Recurrence