title: Surgical treatment of perianal abscess and fistula-in-ano in childhood, with emphasis in children older than 2 years.
abstract: BACKGROUND
  Anal sepsis in children ranges from perianal abscess to fistula-in-ano. It is mostly observed in boys younger than 2 years. Most are treated conservatively. In contrast, anal sepsis in older children presents significant similarities to that of adults and is predominantly treated surgically. We report our outcomes after surgical treatment of anal abscess and fistula-in-ano in children older than 2 years.
  
  
  METHODS
  Ninety-eight (98) children were operated on for anal abscess (46 patients; 47%) and/or fistula-in-ano (52 patients; 53%). Incision and drainage of the abscess was performed as outpatients. In patients with fistulas, fistulotomy was the main treatment approach. All patients were healthy without risk factors for anal sepsis.
  
  
  RESULTS
  In patients with anal abscess treated with incision and drainage, low recurrence (13%) or fistula formation rates were observed. Most anal fistulas were simple entities. Significant involvement of the anal sphincter was found in 3 (6%) of 52 patients. An abscess cavity between the anal canal and the perianal skin was found in 4 (8%) of 52 patients, and an enlarged cryptic gland was found in 5 (10%) of 52 cases. Fistulotomy was performed in all patients with additional seton placement in 3 (6%) of 52 and a cryptotomy in 5 (10%) of 52 patients.
  
  
  CONCLUSIONS
  Anal abscesses in children are easily treated by incision and drainage with low recurrence of perianal sepsis. Fistulas can be treated successfully in most patients with a fistulotomy, whereas complex fistulas are uncommon.
authors.affiliation: Third Department of General Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece. chalaral@med.uoa.gr
authors.forename: Anestis
authors.initials: A
authors.lastname: Charalampopoulos
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Zavras
authors.forename: Emmanouil I
authors.initials: EI
authors.lastname: Kapetanakis
authors.forename: Kostantinos
authors.initials: K
authors.lastname: Kopanakis
authors.forename: Evangelos
authors.initials: E
authors.lastname: Misiakos
authors.forename: Pavlos
authors.initials: P
authors.lastname: Patapis
authors.forename: Georgios
authors.initials: G
authors.lastname: Martikos
authors.forename: Anastasios
authors.initials: A
authors.lastname: Machairas
mesh_terms: D000038:Abscess / Q000175:diagnosis / Q000601:surgery*; D000293:Adolescent; D001004:Anus Diseases / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012003:Rectal Fistula / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome