Our Summary

This research paper compares two treatments for anal fistula, a condition that causes an abnormal connection between the skin and the anus. The first treatment is radiofrequency thermocoagulation, a process that uses heat generated by radio waves to seal off the fistula. The second is rectal advancement flap, a surgical procedure that involves moving healthy tissue to cover the fistula.

The study included 62 patients, some of whom suffer from Crohn’s disease, an inflammatory bowel disease that can cause fistulas. The results showed that the failure rate of the radiofrequency treatment was higher than that of the rectal flap treatment. In fact, the likelihood of radiofrequency treatment failing increased over time. Additionally, some patients in the radiofrequency group experienced complications, like needing drainage for an abscess or severe thermal ulceration.

The researchers concluded that radiofrequency thermocoagulation is less effective and satisfactory for treating anal fistula than the rectal flap procedure. Also, having Crohn’s disease was found to be a key factor in predicting successful healing from these procedures.

FAQs

  1. What are the two treatments for anal fistula discussed in the research paper?
  2. How did the effectiveness of radiofrequency thermocoagulation compare to rectal advancement flap in treating anal fistula?
  3. How does having Crohn’s disease impact the success rate of anal fistula treatments?

Doctor’s Tip

A doctor might advise a patient undergoing anal fistula surgery to carefully consider their treatment options and discuss the potential risks and benefits with their healthcare provider. It’s important to understand that while radiofrequency thermocoagulation may be a less invasive option, the study suggests that the rectal advancement flap procedure may be more effective in the long term. Patients with Crohn’s disease should especially take this into consideration when choosing a treatment plan. It’s also important to follow post-operative care instructions and attend follow-up appointments to monitor healing and address any complications that may arise.

Suitable For

Patients who are typically recommended anal fistula surgery are those who have not had success with conservative treatments such as antibiotics or drainage procedures. In particular, patients with complex fistulas, multiple fistulas, or recurrent fistulas may be candidates for surgical intervention. Additionally, patients with underlying conditions such as Crohn’s disease may benefit from surgery to treat their fistula.

In this study, the researchers found that patients with Crohn’s disease had a higher likelihood of successful healing after the rectal flap procedure compared to the radiofrequency thermocoagulation treatment. This suggests that patients with Crohn’s disease may be more likely to benefit from surgical intervention for their anal fistula.

Overall, patients who continue to experience symptoms and complications from their anal fistula despite conservative treatments may be recommended for surgery to improve their quality of life and reduce the risk of further complications.

Timeline

  • Before surgery: Patients may experience symptoms of an anal fistula, such as pain, swelling, discharge, and difficulty with bowel movements. They may have undergone imaging tests, like MRI or ultrasound, to diagnose the fistula and determine the best course of treatment. Patients may also have tried conservative treatments, like antibiotics or drainage, to manage their symptoms.

  • Day of surgery: Patients will undergo anesthesia before the procedure, which may be performed as an outpatient or require a hospital stay. The surgeon will make an incision to access the fistula and either use radiofrequency thermocoagulation or rectal advancement flap to treat it. The surgery typically takes about 30-60 minutes.

  • After surgery: Patients may experience pain, swelling, and discomfort in the anal area following surgery. They will be given pain medication and instructions for wound care. Some patients may need a temporary colostomy bag to allow the area to heal. Follow-up appointments with the surgeon will be scheduled to monitor healing and address any complications.

  • Weeks to months post-surgery: Patients should gradually start to feel better as the area heals. They may need to make dietary and lifestyle changes to prevent recurrence of the fistula. Follow-up appointments will continue to monitor healing and address any lingering symptoms or complications.

Overall, the timeline for a patient before and after anal fistula surgery involves diagnosis, treatment decision-making, surgery, post-operative care, and follow-up appointments to ensure successful healing and recovery.

What to Ask Your Doctor

  1. What are the risks and potential complications associated with anal fistula surgery?

  2. How long is the recovery time for each type of surgery?

  3. What is the success rate of each procedure in treating anal fistulas?

  4. Are there any specific factors, such as having Crohn’s disease, that may affect the outcome of the surgery?

  5. What type of follow-up care will be needed after the surgery?

  6. Are there any lifestyle changes or precautions that need to be taken after the surgery to prevent recurrence of the fistula?

  7. Are there any alternative treatments or procedures that could be considered for treating the anal fistula?

  8. How experienced is the surgeon in performing the specific type of surgery being recommended?

Reference

Authors: Merlini l’Héritier A, Siproudhis L, Bessi G, Le Balc’h E, Wallenhorst T, Bouguen G, Brochard C. Journal: Colorectal Dis. 2019 Aug;21(8):961-966. doi: 10.1111/codi.14618. Epub 2019 Apr 3. PMID: 30897291