Abstract
BACKGROUND: The current study aims to comprehensively evaluate the surgical impact on anal function in pediatric patients with anal fistulas, incorporating anorectal manometry, histopathological examination, and various rating scales. METHODS: The study focuses on infants and toddlers diagnosed with anal fistulas who underwent surgical intervention at Longhua Hospital, Shanghai University of Traditional Chinese Medicine, between November 2020 and January 2024. The participants were divided into two age cohorts: infants (0-12 months) and toddlers (13-36 months). Data were meticulously collected for both cohorts, with anal function assessed through intraoperative anorectal manometry, Masson staining of fistula tissue, and the Heikkinen clinical continence scoring (CCS) scale during the postoperative period RESULTS: (1) Both cohorts demonstrated a 100% postoperative healing rate. The average healing duration was 15.58 ± 3.21 days for the infant cohort and 16.57 ± 3.65 days for the toddler cohort. Anorectal manometry indicated the presence of the anorectal inhibitory reflex (RAIR) in both cohorts. Postfistulotomy, there was a slight decrease in anal rectal pressure (ARP), although this reduction was not statistically significant (p > 0.05) and was unrelated to the complexity of the fistula. Pathological examination of the fistula tissues revealed low muscle content in both cohorts, accounting for 14.1 ± 1.35% in the infant cohort and 17.2 ± 2.86% in the toddler cohort. The muscle composition varied between the cohorts; the infant cohort predominantly had smooth muscle with minimal striated muscle, whereas the toddler cohort had both smooth and striated muscle, with a relatively higher proportion of striated muscle. The CCS scores showed significant improvement at 6 months postoperation and during long-term follow-up compared to preoperative scores, with long-term follow-up results being superior to those at six months (p < 0.01). CONCLUSION: Surgical treatment for pediatric anal fistulas demonstrates is both effective and safe, with a potential for long-term improvement in anorectal function over time.