Incision and Drainage With Primary Fistulotomy of Perianal Abscess Is Safe and Effective in Neonates: A Long-Term Follow-Up Study

Abstract

ObjectivePerianal abscess (PA) in neonates is poorly understood, and its management remains controversial. The aim of this study was to compare incision and drainage (ID) with or without primary fistulotomy in the management of neonatal first-time PA.MethodsA retrospective comparative study was conducted for neonates with first-time PA treated with incision and drainage with primary fistulotomy (IDF) vs. ID between 2008 and 2017.ResultsIn total, 138 patients (137 boys and 1 girl) were identified; 65 in the IDF group and 73 in the ID group. The median follow-up was 6.5 years (range 4–13 years). Baseline characteristics were similar between the 2 groups. The cure rate in the IDF group (98.5%, 64/65) was significantly higher than that in the ID group (80.8%, 59/73; p = 0.001). The rate of fistula formation in the IDF group (1.5%, 1/65) was significantly lower than that in the ID group (13.7%, 10/73; p = 0.01). The rate of abscess recurrence was not statistically different (p = 0.12), even though the IDF group (0%, 0/65) seemed to have a better outcome than the ID group (5.5%, 4/73). No fecal incontinence was observed in any of our patients.ConclusionsFirst-time PA in neonates can be treated safely and effectively by the IDF or by ID alone. The former may be advantageous over the latter in terms of the rate of cure and fistula formation.

A Systematic Review and Meta-Analysis of Comparing Drainage Alone versus Drainage with Primary Fistula Treatment for the Perianal Abscess in Children

“…Ultimately, 16 NRSs were eligible for the final meta-analysis. Eight studies were retrospective 12,[29][30][31][32][33][34][35] , 7 were prospective [36][37][38][39][40][41][42] , and 1 was NR 43 . Among these, 11 articles were in Chinese, and 5 studies in English were from New Zealand, Sweden, Australia, the UK, and China, respectively.…”

“…The age of patients, disease duration, and follow-up period was described in a variety of ways. The youngest age of patients in the included studies was all less than 28 days 34,35 . All reported disease durations were less than 30 days in 8 studies 30,[35][36][37]39,40,42,43 , and just 1 article demonstrated the longest duration was 91 days 38 .…”

“…The youngest age of patients in the included studies was all less than 28 days 34,35 . All reported disease durations were less than 30 days in 8 studies 30,[35][36][37]39,40,42,43 , and just 1 article demonstrated the longest duration was 91 days 38 . The follow-up in most studies was longer than 6 months, and the longest one was 13 years 35 .…”

“…All reported disease durations were less than 30 days in 8 studies 30,[35][36][37]39,40,42,43 , and just 1 article demonstrated the longest duration was 91 days 38 . The follow-up in most studies was longer than 6 months, and the longest one was 13 years 35 . Further treatment information of included NRSs was demonstrated in Table 2.…”

“…Further treatment information of included NRSs was demonstrated in Table 2. The anesthetic approaches comprised general and nongeneral anesthesia, including caudal and local anesthesia with or without conscious sedation 30,32,33,35,[38][39][40] . Intravenous anesthesia was performed as one of the anesthetic techniques of administration 39 .…”