Our Summary

This study compares the outcomes of two groups of patients who underwent a specific surgical procedure for anal fistula - a kind of abnormal connection between the skin and the inside of the anus. One group had the surgery in an outpatient setting (ambulatory surgery), meaning they didn’t need to stay in the hospital overnight, while the other group stayed in the hospital for the procedure (in-patient surgery).

The researchers found that the patients who had outpatient surgery were generally younger and more educated. They also returned to work faster after their procedure. However, they experienced more postoperative pain and a higher incidence of a certain complication (external hemorrhoidal thrombosis). Despite this, the overall rate of complications and readmissions to the hospital within 30 days was the same for both groups.

Interestingly, the patients who had outpatient surgery reported higher satisfaction with the procedure than those who stayed in the hospital. The researchers concluded that this specific surgery for anal fistula can be safely performed on an outpatient basis, leading to a quicker return to work and acceptable levels of patient satisfaction.

FAQs

  1. What were the main differences between the outcomes of outpatient and in-patient surgeries for anal fistula?
  2. Did the study find that one method (outpatient vs in-patient surgery) was better than the other for anal fistula surgery?
  3. What were the rates of complications and readmissions to the hospital for patients who underwent outpatient and in-patient surgeries for anal fistula?

Doctor’s Tip

One helpful tip a doctor might tell a patient about anal fistula surgery is to carefully follow postoperative instructions, including proper wound care and taking prescribed medications as directed. It is important to report any unusual symptoms or signs of infection to your healthcare provider promptly. Additionally, maintaining good hygiene and following a healthy diet can help promote healing and prevent complications after surgery.

Suitable For

Patients who are typically recommended anal fistula surgery are those who have not responded to other non-surgical treatments such as medications or drainage procedures. They may be experiencing symptoms such as recurrent anal abscesses, pain, swelling, discharge, and difficulty controlling bowel movements. The decision to undergo surgery is usually made in consultation with a colorectal surgeon after a thorough evaluation of the patient’s condition.

Timeline

Before anal fistula surgery:

  • Patient experiences symptoms such as pain, swelling, discharge, and possibly fever due to the anal fistula
  • Patient consults with a doctor who performs a physical examination and may order imaging tests to confirm the diagnosis
  • Treatment options are discussed, including surgery to remove the fistula

After anal fistula surgery:

  • Patient undergoes surgery to remove the anal fistula, either as an outpatient or in-patient procedure
  • Patients who have outpatient surgery may experience more postoperative pain but return to work faster
  • Patients who have in-patient surgery may have a longer recovery time but may experience less postoperative pain
  • Both groups of patients have a similar rate of complications and readmissions to the hospital within 30 days
  • Patients who have outpatient surgery report higher satisfaction with the procedure
  • Overall, anal fistula surgery can be safely performed on an outpatient basis with acceptable levels of patient satisfaction.

What to Ask Your Doctor

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

  1. What are the potential risks and complications associated with this surgery?
  2. Will I need to stay in the hospital overnight, or can the surgery be done on an outpatient basis?
  3. What is the expected recovery time and when can I return to work?
  4. How will postoperative pain be managed?
  5. What follow-up care will be needed after the surgery?
  6. What is the success rate of this surgery for treating anal fistulas?
  7. Are there any alternative treatment options available?
  8. How experienced is the surgeon in performing this specific procedure?
  9. What should I expect in terms of postoperative care and wound management?
  10. How can I best prepare for the surgery and optimize my recovery?

Reference

Authors: Qiu JM, Yang GG, Wang HT, Fu C, Wang D, Mei T. Journal: BMC Gastroenterol. 2019 May 30;19(1):81. doi: 10.1186/s12876-019-0997-x. PMID: 31146697