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CC BY-NC-ND 4.0 · Eur J Pediatr Surg
DOI: 10.1055/a-2070-3613
Review Article

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

Yanting Sun    *
1   Department of Proctology, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China
2   Institute of Traditional Chinese Medicine Surgery, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China
,
Shuang Hao   *
1   Department of Proctology, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China
,
Xi Zhang
1   Department of Proctology, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China
,
Hongtao Liang
1   Department of Proctology, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China
,
Yibo Yao
1   Department of Proctology, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China
,
Jingen Lu
1   Department of Proctology, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China
,
Chen Wang
1   Department of Proctology, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China
2   Institute of Traditional Chinese Medicine Surgery, Longhua Hospital affiliated to Shanghai University of TCM, Shanghai, P. R. China
› Author Affiliations Funding This study was funded by the Shanghai Health Commission [grant number ZY(2021-2023)0209-06], Shanghai Health Commission [grant number 20224Y0161], and Shanghai Hospital Development Center [grant number SHDC22021316A].
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Abstract

This systematic review and meta-analysis of nonrandomized studies (NRSs) aimed to evaluate the clinical efficacy and safety of two types of surgical interventions (respectively drainage alone and drainage with primary fistula treatment) for perianal abscesses (PAs) in children. Studies from 1992 to July 2022 were searched in 10 electronic databases. All relevant NRSs with available data which compared surgical drainage with or without primary fistula treatment were included. Patients with underlying diseases which led to abscess formation were excluded. The Newcastle-Ottawa Scale was used to assess the risk of bias and quality of the included studies. The outcomes were the healing rate, fistula formation rate, fecal incontinence, and wound healing duration. A total of 16 articles with 1,262 patients were considered suitable for the final meta-analysis. Primary fistula treatment was associated with a significantly higher healing rate when compared with incision and drainage alone (odds ratio [OR]: 5.76, 95% confidence interval [CI]: 4.04–8.22). This aggressive procedure for PA resulted in an 86% reduction in the fistula formation rate (OR: 0.14, 95% CI: 0.06–0.32). Limited data showed patients who underwent primary fistula treatment have a minor effect on postoperative fecal incontinence. Primary fistula treatment demonstrates a better clinical efficacy in promoting the healing rate and decreasing the formation of fistulas in PAs in children. The available evidence for a minor impact on anal function after this intervention is less strong.

Keywords

systematic review - meta-analysis - perianal abscess - children - primary fistula treatment

Data Availability

All data generated or analyzed during this study are included in this published article and its supplementary information files.


* These authors contributed equally to the paper and retain the first authorship.


Supplementary Material



Publication History

Received: 03 February 2023

Accepted: 28 March 2023

Accepted Manuscript online:
06 April 2023

Article published online:
01 June 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
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