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

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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

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

Xue-Cheng Zhang, Huang-Fu Ma, Zhang-Yun Zhou, Li-Na Zhang, Fang Kong, Yan-Mei Wang, Xin-Bo Song, Yue Wang

Xue-Cheng Zhang, Huang-Fu Ma, Yan-Mei Wang, Xin-Bo Song, Yue Wang, Department of Proctology, China-Japan Friendship Hospital, Beijing 100029, China

Zhang-Yun Zhou, Department of Gastrointestinal Surgery, Anhui Zhongke Gengjiu Hospital, Hefei 230051, Anhui Province, China

Li-Na Zhang, Department of Traditional Chinese Medicine Proctology, Hohhot Traditional Chinese and Mongolian Medicine Hospital, Hohhot 010000, Inner Mongolia Autonomous Region, China

Fang Kong, College of Acupuncture and Massage, Shandong University of Traditional Chinese Medicine, Jinan 250355, Shandong Province, China

Co-first authors: Xue-Cheng Zhang and Huang-Fu Ma.

Co-corresponding authors: Xin-Bo Song and Yue Wang.

Author contributions: Zhang XC and Ma HF drafted the manuscript, they contributed equally to this work as co-first authors; Wang Y and Song XB participated in the study design and coordination, they contributed equally to this work as they are co-corresponding authors; Zhang LN and Zhou ZY handled follow-up and data/picture collection; Zhang XC and Wang Y performed data curation; Kong F conducted software and formal analysis; Zhang XC, Ma HF, Zhou ZY, Zhang LN, Kong F, Wang YM, Song XB, Wang Y read and approved the final version.

AI contribution statement: AI tools (specifically ChatGPT) were used solely for linguistic refinement and formatting assistance. No AI tool was involved in the generation of research data, interpretation of results, or formulation of conclusions. All AI-generated outputs were critically reviewed and revised by the authors. AI tools (ChatGPT) were used solely for linguistic refinement and formatting assistance in the “Answering Reviewers”.

Supported by Independent Research Project of China-Japan Friendship Hospital, No. 2024-ZF-31.

Institutional review board statement: The study was approved by the Ethics Committee of China-Japan Friendship Hospital (approval No. 2024-KY-387).

Informed consent statement: The study was approved by the Ethics Committee of China-Japan Friendship Hospital, which waived the requirement for written informed consent. Verbal informed consent was obtained from all participants via telephone prior to enrollment.

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.

Data sharing statement: All data supporting this study are included within the article and/or its Supplementary material.

Corresponding author: Yue Wang, MD, PhD, Doctor, Department of Proctology, China-Japan Friendship Hospital, No. 2 Yinghuayuan East Street, Chaoyang District, Beijing 100029, China. wangyue@zryhyy.com.cn

Received: April 2, 2026
Revised: April 30, 2026
Accepted: May 20, 2026
Published online: September 21, 2026
Processing time: 135 Days and 19.3 Hours

Abstract

BACKGROUND

Fistulotomy is a common treatment for fistula-in-ano (FIA) in children. However, the perioperative safety and long-term effectiveness of fistulotomy under general anesthesia (GA) in infants and toddlers remains uncertain.

AIM

To investigate the clinical characteristics of toddlers and infants undergoing fistulotomy and evaluate the perioperative safety and long-term outcomes.

METHODS

This retrospective cohort study was conducted at the China-Japan Friendship Hospital and included hospitalized patients aged 3 ≤ years who were diagnosed with FIA and underwent fistulotomy between January 2018 and March 2024. The primary outcome was perianal abscess or FIA recurrence rate during follow-up in infants (12 months) and toddlers (aged 1-3 years) after fistulotomy, which was also assessed using cox regression to identify associated risk factors. Secondary outcomes included perioperative adverse events and Kelly score.

RESULTS

A total of 675 patients (540 infants and 135 toddlers) with a median age of 11 months were included. Infants had a significantly shorter disease course and fistula incidence at the 4:00 and 8:00 (P < 0.05) positions compared with toddlers. A single case of severe intraoperative respiratory distress was successfully managed during GA. Common postoperative adverse events included somnolence and fever. After an average follow-up period of 30 months, the overall recurrence rate was 1.5%, which was significantly higher in toddlers (3.7%) than in infants (0.9%). Univariate and multivariate Cox regression identified toddlers and specific fistula locations (L5 and L9) as independent risk factors for recurrence in children under 3 years of age.

CONCLUSION

Fistula patterns and recurrence showed age-related differences. Fistulotomy under GA appears to be a safe and effective option for infants/toddlers with FIA, with low recurrence and a negligible impact on fecal continence.

Keywords: Fistula-in-ano; Anal fistula; Fistulotomy; Infants; Toddlers; General anesthesia

Core Tip: Infants and toddlers differ in fistula location patterns and surgical outcomes, likely reflecting the distinct developmental pathological processes that evolve in early childhood. Our study reveals fistulotomy under general anesthesia appears to be a safe and effective option for infants/toddlers with fistula-in-ano, with low recurrence rate and a negligible impact on fecal continence. Given this favorable safety record, the potential risks of general anesthesia should be balanced against the benefits of definitive treatment, and necessary surgical intervention should not be postponed because of anesthesia concerns.