Fistulotomy under general anesthesia in infants and toddlers: A retrospective cohort study on perioperative safety and long-term recurrence

doi:10.3748/wjg.121507

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Sep 21, 2026; 32(35): 121507
Published online Sep 21, 2026. doi: 10.3748/wjg.121507

Table 1 Baseline characteristics and surgical outcomes of infants and toddlers with fistula-in-ano, n (%)/median interquartile range

Characteristic	Overall (n = 675)	Infants (n = 540)	Toddlers (n = 135)	P value
Male	675 (100)	540 (100)	135 (100)
Mean age at the operation (month)	11.00 (7.00, 12.00)	9.00 (7.00, 12.00)	24.00 (21.00, 36.00)	< 0.001
Interval between the operation and the first anal fistula (month)	5.00 (2.00, 8.00)	4.00 (2.00, 7.00)	8.00 (1.50, 12.00)	< 0.001
History of incision and drainage	60 (8.9)	50 (9.3)	10 (7.4%)	0.499
Weight (kg)	11.80 (6.90)	10.78 (4.51)	15.89 (11.67)	< 0.001
Height (cm)	78.29 (11.61)	74.97 (8.56)	91.54 (12.75)	< 0.001
Systolic blood pressure (mmHg)	88.34 (9.52)	87.90 (9.17)	90.08 (10.66)	0.030
Diastolic blood pressure (mmHg)	55.09 (7.49)	54.71 (7.17)	56.60 (8.52)	0.442
Respiratory rate on admission (once/minute)	22.20 (3.07)	22.26 (2.07)	21.94 (5.47)	0.508
Heart rate on admission (once/minute)	112.20 (9.53)	113.40 (8.23)	107.39 (12.47)	< 0.001
Temperature on admission (°C)	36.47 (0.68)	36.50 (0.25)	36.35 (1.43)	0.243
Duration of operation (minute)	16.00 (10.00, 20.00)	16.00 (10.00, 20.00)	17.00 (11.00, 21.50)	0.199
Adverse events
Fever/pyrexia	129 (19.1)	119 (22.0)	10 (7.4)	< 0.001
Sleepiness	74 (13.7)	53 (9.8)	21 (15.6)	0.056
Oral antibiotics after operation	587 (87.0)	470 (87.0)	117 (86.7)	0.909
Topical antibiotics after operation	540 (80.0)	432 (80.0)	108 (80.0)	1.000
Hospital stay (day)	3.00 (3.00, 4.00)	3.00 (3.00, 4.00)	3.00 (3.00, 4.00)	0.691
Time to complete wound healing (week)	4.00 (3.00, 4.00)	4.00 (3.00, 4.00)	4.00 (3.00, 4.00)	0.139
Recurrence of anal fistula	10 (1.5)	5 (0.9)	5 (3.7)	0.046
Follow-up (month)	30.00 (16.00, 57.00)	29.00 (15.00, 56.00)	35.00 (17.00, 60.50)	0.084

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Table 2 Characteristics of fistula of infants and toddlers, n (%)

Characteristic	Overall (n = 675)	Infants (n = 540)	Toddlers (n = 135)	P value
Number of fistulas (n = 1194)				0.085
1	364 (53.9)	296 (54.8)	68 (50.4)
2	163 (24.1)	135 (25.0)	28 (20.7)
≥ 3	148 (21.9)	109 (20.2)	39 (28.9)
Direction of fistulas (lithotomy site)
L1	106 (15.7)	84 (15.6)	22 (16.4)	0.673
L2	53 (7.9)	42 (7.8)	11 (8.2)	0.886
L3	321 (47.6)	256 (47.4)	65 (48.5)	0.877
L4	18 (2.7)	9 (1.7)	9 (6.7)	0.001
L5	93 (13.8)	71 (13.1)	22 (16.4)	0.343
L6	21 (3.1)	14 (2.6)	7 (5.2)	0.121
L7	76 (11.3)	58 (10.7)	18 (13.4)	0.394
L8	15 (2.2)	8 (1.5)	7 (5.2)	0.009
L9	342 (50.7)	276 (51.1)	66 (49.3)	0.644
L10	46 (6.8)	35 (6.5)	11 (8.2)	0.492
L11	89 (13.2)	70 (13.0)	19 (14.2)	0.733
L12	14 (2.1)	13 (2.4)	1 (0.7)	0.323

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Table 3 Long-term functional outcomes of patients after according to Kelly’s score, n (%)

	Overall (n = 675)
Leakage
0	2 (0.3)
1	8 (1.2)
2	665 (98.5)
Muscle strength
0	2 (0.3)
1	8 (1.2)
2	665 (98.5)
Sensitivity
0	0 (0)
1	6 (0.9)
2	669 (99.1)
Kelly’s score
0-2	2 (0.3)
3-4	8 (1.2)
5-6	665 (98.5)
Mean Kelly’s score of continence	5.96 ± 0.34

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Table 4 Univariate and multivariate Cox regression analysis of risk factors for fistula-in-ano or perianal abscess recurrence

Variable	Univariate		Multivariate
Variable	HR (95%CI)	P value	HR (95%CI)	P value
Toddlers (vs infants)	3.905 (1.130-13.491)	0.031¹	4.808 (1.330-17.375)	0.017¹
History of incision and drainage	3.859 (0.804-18.525)	0.092
Oral antibiotics after operation	2.140 (0.442-10.359)	0.344
Topical antibiotics after operation (yes)	0.787 (0.199-3.109)	0.733
Numbers of fistula
2	8.675 (0.969-77.626)	0.053	5.390 (0.582-49.931)	0.138
≥ 3	12.176 (1.422-104.226)	0.023¹	1.900 (0.150-24.010)	0.62
Course of disease² (month)
3-6 months	0.406 (0.082-2.011)	0.269
6-36 months	0.213 (0.043-1.057)	0.059
Duration of operation (minute)	1.020 (0.937-1.110)	0.651
Direction of fistulas
L1	1.237 (0.263-5.829)	0.788
L2	0.000 (0.000-0.000)	0.998
L3	4.465 (0.948-21.026)	0.058
L4	0.000 (0.000-0.000)	0.998
L5	6.539 (1.891-22.615)	0.003¹	8.136 (1.539-43.014)	0.014¹
L6	0.000 (0.000-0.000)	0.998
L7	0.876 (0.111-6.916)	0.9
L8	5.224 (0.662-41.253)	0.117
L9	8.525 (1.080-67.305)	0.042¹	9.585 (1.049-87.581)	0.045¹
L10	0.000 (0.000-0.000)	0.998
L11	0.000 (0.000-0.000)	0.998
L12	0.000 (0.000-0.000)	0.998

¹Indicates a significant result.

²Course of disease refers to interval between the operation and the first anal fistula or perianal abscess.

CI: Confidence interval; HR: Hazard ratio.

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Citation: Zhang XC, Ma HF, Zhou ZY, Zhang LN, Kong F, Wang YM, Song XB, Wang Y. Fistulotomy under general anesthesia in infants and toddlers: A retrospective cohort study on perioperative safety and long-term recurrence. World J Gastroenterol 2026; 32(35): 121507
URL: https://www.wjgnet.com/1007-9327/full/v32/i35/121507.htm
DOI: https://dx.doi.org/10.3748/wjg.121507

Zhang XC, Ma HF, Zhou ZY, Zhang LN, Kong F, Wang YM, Song XB, Wang Y. Fistulotomy under general anesthesia in infants and toddlers: A retrospective cohort study on perioperative safety and long-term recurrence. World J Gastroenterol 2026; 32(35): 121507 [DOI: 10.3748/wjg.121507]

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