title: Fistula in ano in infants: who recurs?
abstract: BACKGROUND
  Fistula in ano is a common malady in infancy. However, relatively little literature is devoted to it. Our aim was to describe the natural history and identify predictors of which children will ultimately recur.
  
  
  METHODS
  A retrospective review of patients less than 3 years old undergoing anal fistulotomy was performed between May 2002 and November 2007 at a tertiary children's hospital. Demographics, preoperative, operative, and postoperative characteristics were collected in each group and evaluated by biostatistical analysis. P values <0.05 were considered significant.
  
  
  RESULTS
  A total of 92 children undergoing anal fistulotomy were identified. The median age was 6 months. Twelve children (13%) had recurrences and two of the 12 had multiple recurrences. Children who had recurrences were older (12.9 vs. 7.5 months, P < 0.05) and were more likely to have a previous abscess (20 vs. 6%, P < 0.05). In addition, children with recurrences had pus noted at the time of surgery more than children who did not recur (23 vs. 8%, respectively, P < 0.05). There were no major complications.
  
  
  CONCLUSIONS
  Fistula in ano in infants is a relatively benign process with most children having no serious sequelae. However, a not insignificant portion (13%) of children developed recurrences. Older children who developed fistulas were more likely to have a recurrence than younger, and children who had previous episodes of perianal abscess or pus noted at the time of surgery were more likely to recur.
authors.affiliation: Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr. EH 202, Indianapolis, IN 46202, USA. nmnovotn@iupui.edu
authors.forename: Nathan M
authors.initials: NM
authors.lastname: Novotny
authors.forename: Monica J S
authors.initials: MJ
authors.lastname: Mann
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Rescorla
mesh_terms: D002675:Child, Preschool; D005260:Female; D005401:Fissure in Ano / Q000453:epidemiology* / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D018709:Statistics, Nonparametric