Our Summary

This study looked at the long-term results of a surgical procedure used to treat a specific type of anal fistula, a small tunnel that develops between the end of the bowel and the skin near the anus. The procedure aims to preserve the function of the sphincter, a ring of muscle that controls the passage of bowel movements.

The researchers looked at the records of patients who had this surgery between 2012 and 2018 in two Dutch hospitals. They were interested in how well patients could control their bowel movements after the surgery. They used a score to measure this, and they also looked at how well the fistulas healed and whether they came back.

Out of 110 patients, most had had previous surgeries, and 80% had had a specific type of treatment before the surgery in question. Before the surgery, 16% of the patients had problems controlling their bowel movements. After the surgery, this rose to 18%, including 11% who had not had problems before.

In the long term, 74% of the patients who responded to a questionnaire reported problems with bowel control. Among those who didn’t need more surgery, almost half reported these problems. The fistula healed after the surgery in just over a quarter of the patients. Previous treatment significantly improved the healing rates.

The researchers concluded that the healing rates were lower than what other studies had reported. The rates of problems with bowel control were also concerning in the long term. They recommend that doctors and researchers take a patient-centered approach and collect more data on bowel control after this surgery.

FAQs

  1. What is the purpose of the surgical procedure discussed in the study?
  2. What were the long-term results of the surgery on patients’ ability to control their bowel movements?
  3. What was the healing rate for patients after undergoing the anal fistula surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about anal fistula surgery is to follow the post-operative care instructions carefully to promote healing and reduce the risk of complications. This may include keeping the area clean, taking prescribed medications as directed, and avoiding activities that could strain the surgical site. It’s also important to attend follow-up appointments with your healthcare provider to monitor your recovery progress and address any concerns promptly.

Suitable For

Patients who are typically recommended anal fistula surgery are those who have tried other treatments that have not been successful, such as antibiotics or drainage procedures. They may also have recurrent or complex fistulas that require surgical intervention. Additionally, patients who are experiencing symptoms such as pain, discharge, or difficulty controlling their bowel movements may be candidates for surgery. It is important for patients to discuss their symptoms and treatment options with their healthcare provider to determine if surgery is the best course of action for their specific situation.

Timeline

Before anal fistula surgery:

  • Patient may experience symptoms such as pain, swelling, discharge, and difficulty controlling bowel movements
  • Patient may undergo imaging tests to diagnose the fistula and determine the best course of treatment
  • Patient may try conservative treatments such as antibiotics or sitz baths before considering surgery

After anal fistula surgery:

  • Patient will have a period of recovery, which may involve pain, swelling, and discomfort
  • Patient will need to follow post-operative care instructions, such as wound care and dietary restrictions
  • Patient will have follow-up appointments to monitor healing and address any complications
  • In the long term, patient may experience problems with bowel control, with some patients reporting ongoing issues even after successful surgery

Overall, the timeline for a patient before and after anal fistula surgery involves a period of symptoms and diagnosis, followed by surgery and recovery, with ongoing monitoring and potential long-term issues with bowel control.

What to Ask Your Doctor

Some questions a patient should ask their doctor about anal fistula surgery include:

  1. What are the risks and potential complications of this surgery?
  2. How long is the recovery period, and what can I expect during this time?
  3. Will I need to make any lifestyle changes after the surgery?
  4. What is the success rate of this surgery in terms of fistula healing and bowel control?
  5. Are there any alternative treatment options available for my condition?
  6. How many times have you performed this specific procedure, and what is your success rate?
  7. Will I need any additional treatments or follow-up procedures after the surgery?
  8. How soon can I return to work and normal activities after the surgery?
  9. Will I need to follow a specific diet or take any medications after the surgery?
  10. What can I do to minimize the risk of the fistula coming back in the future?

Reference

Authors: van Oostendorp JY, Verkade C, Han-Geurts IJM, van der Mijnsbrugge GJH, Wasowicz-Kemps DK, Zimmerman DDE. Journal: BJS Open. 2024 May 8;8(3):zrae055. doi: 10.1093/bjsopen/zrae055. PMID: 38843378