Recurring Infections After Back Fistula Surgery in Children

Back fistula surgery

Hello, my child underwent a back fistula surgery in January.
Since he is a child, the doctor sutured the wound at that time.
However, the surgical site has been repeatedly red and swollen, and eventually the wound has broken open and discharged pus.
In February, he was hospitalized for two weeks to receive antibiotics and underwent another debridement surgery before being discharged.
Even now, this situation continues to recur.
The surgeon has advised us to return for more antibiotics.
What could be the reason for this? Can continuous antibiotic treatment resolve the issue? Thank you.

Ellen, 30~39 year old female. Ask Date: 2017/03/27

Dr. Ke Fangxu reply Surgery

The definition of a fistula refers to an abnormal connection between an internal organ and the skin or another organ that should not exist.
Therefore, a fistula should not occur in the back unless it is a connection with the pleural cavity.
If that is the case, it would be quite complex and not within my area of expertise.
It is likely that a skin lesion on the back, after excision, did not heal properly and resulted in a chronic infection.
If this is the case, it is important to determine whether the lesion has been completely excised.
If it has not been thoroughly removed and only debrided, it is very easy for the infection to recur.
I recommend complete excision of the lesion followed by antibiotic treatment to reduce the likelihood of recurrence.

Reply Date: 2017/03/27

More Info

It sounds like you are going through a very challenging time with your child's health, and I want to reassure you that your concerns are valid and important. Recurring infections after surgery, particularly in children, can be distressing for both the child and the parents. Let's break down your questions and concerns regarding your child's situation after the back fistula surgery.

Understanding Recurring Infections
1. Reasons for Recurring Infections: After any surgical procedure, especially one involving the skin and soft tissues like a fistula surgery, there can be several reasons for recurring infections. These may include:
- Inadequate Healing: Sometimes, the surgical site may not heal properly, leading to pockets of infection or fluid accumulation.

- Foreign Body Reaction: If any foreign materials (like sutures or surgical mesh) are left in the body, they can provoke an inflammatory response, leading to infection.

- Underlying Conditions: Conditions that affect the immune system or circulation can also predispose a child to infections.

- Bacterial Resistance: If the same antibiotics are used repeatedly, bacteria may develop resistance, making it harder to treat the infection effectively.

2. Role of Antibiotics: Antibiotics are crucial in managing infections, but they are not a standalone solution. While they can help control bacterial growth, they do not address the underlying issues causing the infections. Continuous use of antibiotics without addressing the root cause may lead to antibiotic resistance and other complications.

3. Surgical Site Management: After surgery, proper care of the surgical site is essential. This includes:
- Keeping the area clean and dry.

- Monitoring for signs of infection, such as increased redness, swelling, warmth, or discharge.

- Following up with healthcare providers regularly to assess healing and intervene early if issues arise.

4. When to Seek Further Help: If your child continues to experience recurring infections, it may be necessary to consult with a pediatric surgeon or a specialist in infectious diseases. They may recommend further imaging studies to assess the surgical site or even additional surgical interventions if there are complications like abscess formation.

5. Long-term Outlook: Many children recover well from surgeries like fistula repairs, but some may require additional interventions. The key is to maintain open communication with your healthcare team and ensure that your child receives comprehensive follow-up care.

Emotional and Psychological Support
It's also important to consider the emotional impact of this experience on both your child and yourself. Children can be resilient, but they may also feel anxious or scared about repeated medical interventions. Providing emotional support, reassurance, and a stable environment can help your child cope with the stress of ongoing medical care.

Conclusion
In summary, while antibiotics are an essential part of managing infections, they should be part of a broader strategy that includes proper wound care and regular follow-up with healthcare providers. If your child's condition does not improve, further evaluation may be necessary to identify and address any underlying issues. Remember, you are not alone in this journey, and seeking support from medical professionals and other parents can be invaluable. If you have any further questions or concerns, please feel free to reach out to your healthcare provider.

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