Our Summary

This study looked back at the results of patients who had surgery for anal fistula (a kind of abnormal connection between the anus and the skin) at one hospital, to see how often the problem came back and how often more surgery was needed with different surgical techniques. They looked at 65 patients who had surgery between January 2005 and May 2013 and collected information on their situations before surgery, what the fistula looked like, what kind of surgery was done, how they did after surgery, and follow-up data. They especially looked at how often the fistula closed up and stayed closed after 2 years and how often it came back. They also looked at ongoing pain, problems after surgery, and whether patients could control their bowel movements. Out of 93 total surgeries, 85% healed. The fistula came back most often (42% of the time) in patients who had a certain kind of surgery (anal fistula plug). On the other hand, it never came back in patients who had another kind of surgery (cutting-seton). None of the surgeries left patients with ongoing pain or loss of bowel control. The researchers concluded that we still don’t have a perfect surgery for anal fistula that has a low chance of the problem coming back and is safe for the sphincter (the muscle that controls the anus). However, the cutting-seton technique, which had been considered old-fashioned, had promising results and should be studied more.

FAQs

  1. What were the primary endpoints of this study on anal fistula surgery?
  2. What surgical technique had the highest recurrence rate for anal fistula based on this study?
  3. According to the study, what were the postoperative outcomes for patients who underwent anal fistula surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about anal fistula surgery is to follow post-operative care instructions carefully to promote healing and reduce the risk of recurrence. This may include keeping the area clean, avoiding strenuous activities, and attending follow-up appointments as scheduled. Additionally, it is important to communicate any concerns or symptoms to your healthcare provider promptly to ensure proper management of your recovery.

Suitable For

Patients with anal fistulas are typically recommended surgery when conservative treatments such as antibiotics, drainage, and sitz baths have not been effective in treating the condition. Surgery may be recommended if the fistula is causing symptoms such as pain, swelling, discharge, or recurrent infections. The decision to undergo surgery will depend on the individual patient’s symptoms, the location and complexity of the fistula, and the potential risks and benefits of surgery.

Timeline

Before anal fistula surgery:

  1. Patient experiences symptoms such as pain, swelling, discharge, and itching around the anus.
  2. Patient undergoes a physical examination and possibly additional tests such as a digital rectal exam or imaging studies to diagnose the fistula.
  3. Treatment options are discussed with the patient, including surgery as the most effective option for long-term closure of the fistula.

After anal fistula surgery:

  1. Patient undergoes the chosen surgical technique, which may include fistulotomy, mucosal advancement flap, anal fistula plug, or cutting-seton.
  2. Patient experiences a healing period post-surgery, with follow-up appointments to monitor progress and assess for any complications.
  3. Long-term closure rate and recurrence rate are assessed after 2 years, with the possibility of re-operation if needed.
  4. Patient may experience temporary pain and discomfort post-surgery, but these symptoms should resolve over time.
  5. In this study, the cutting-seton technique showed no recurrence and no persistent pain or incontinence post-surgery, suggesting it may be a promising option for anal fistula treatment.

What to Ask Your Doctor

  1. What are the different surgical techniques available for treating anal fistulas?
  2. What factors determine which surgical technique is most appropriate for my specific case?
  3. What are the potential risks and complications associated with anal fistula surgery?
  4. What is the expected recovery time after surgery?
  5. What is the likelihood of the fistula recurring after surgery?
  6. Will I need any follow-up procedures or treatments after the initial surgery?
  7. How will my continence be affected by the surgery?
  8. Will I experience any persistent pain or discomfort after the surgery?
  9. Are there any lifestyle changes or precautions I should take after the surgery to prevent recurrence?
  10. What is the long-term success rate of the chosen surgical technique for anal fistula treatment?

Reference

Authors: Andreou C, Zeindler J, Oertli D, Misteli H. Journal: Sci Rep. 2020 Apr 16;10(1):6483. doi: 10.1038/s41598-020-63541-3. PMID: 32300218