Our Summary

This research paper aims to understand the risk factors of anal fistula recurrence (AFR), a condition where an abnormal tunnel develops between the skin and the anal canal and reappears after treatment. To come up with a consensus on these risk factors, a two-round survey was conducted among international surgical specialists. The survey was done online and the experts were asked to rate the importance of certain statements related to the recurrence of anal fistulas.

Out of the 60 specialists invited, 38 participated in the first round and 31 in the second round. They represented 13 countries from four continents. After the two rounds, the experts agreed on 14 statements, which fall into three categories: patient-related, fistula-related, and surgery-related risk factors.

Patient-related risk factors include conditions like colitis, inflammatory bowel disease, and the use of immunosuppressants. Fistula-related factors include the type and location of the anal fistula, the number of fistula, and whether it’s recurrent or not. Surgery-related factors involve the type of surgery, previous fistula surgery, and the surgeon performing the surgery.

The findings of this study can help in identifying patients at high risk of AFR. This will allow for early detection and intervention, possibly preventing the recurrence of the condition.

FAQs

  1. What are the three categories of risk factors for anal fistula recurrence that were agreed upon by the experts in the study?
  2. How can the findings of this study help in preventing the recurrence of anal fistulas?
  3. What types of factors were surveyed and rated by the international surgical specialists in the study?

Doctor’s Tip

One helpful tip a doctor might tell a patient about anal fistula surgery is to follow post-operative care instructions carefully, including proper wound care, maintaining good hygiene, and avoiding activities that may put pressure on the surgical site. It is important to attend all follow-up appointments with your healthcare provider to monitor healing and address any concerns promptly. Additionally, maintaining a healthy diet and lifestyle can help improve overall healing and reduce the risk of complications or recurrence.

Suitable For

Anal fistula surgery is typically recommended for patients who have recurrent anal fistulas that are causing symptoms such as pain, swelling, discharge, and difficulty with bowel movements. Patients with complex or high-risk anal fistulas may also be recommended for surgery. Additionally, patients with underlying conditions such as inflammatory bowel disease, Crohn’s disease, or immunosuppression may be recommended for surgery to prevent complications or recurrence of anal fistulas. Ultimately, the decision to undergo anal fistula surgery should be made in consultation with a healthcare provider who can assess the individual patient’s specific situation and recommend the most appropriate treatment approach.

Timeline

Before anal fistula surgery, a patient typically experiences symptoms such as pain, swelling, discharge, and recurrent infections in the anal area. They may have already undergone treatments such as antibiotics, drainage procedures, and seton placement to manage the symptoms.

After anal fistula surgery, patients may experience some pain, discomfort, and swelling in the surgical area. They are usually advised to follow a strict post-operative care regimen, which may include taking antibiotics, pain medications, and stool softeners. Patients are also instructed to keep the surgical area clean and dry, and to avoid strenuous activities and heavy lifting for a certain period of time.

In the weeks following surgery, patients will have follow-up appointments with their healthcare provider to monitor their healing progress and to address any concerns or complications that may arise. It is important for patients to adhere to their healthcare provider’s instructions and to attend all follow-up appointments to ensure proper healing and to minimize the risk of complications or recurrence of the anal fistula.

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 anal fistula surgery?
  2. What is the success rate of the surgery in terms of complete healing and prevention of recurrence?
  3. How long is the recovery period after anal fistula surgery and what can I expect during this time?
  4. Will I need to make any lifestyle changes or follow a special diet after the surgery?
  5. Are there any alternative treatment options for anal fistulas that I should consider?
  6. How experienced is the surgeon in performing anal fistula surgeries?
  7. How will the surgery be performed and what type of anesthesia will be used?
  8. What is the likelihood of the anal fistula recurring after surgery and are there any preventive measures I can take?
  9. Will I need to undergo any follow-up appointments or tests after the surgery?
  10. What can I do to promote healing and reduce the risk of complications after the surgery?

Reference

Authors: Mei Z, Li Y, Wang Q, Shao Z, Du P, Zhu J, Yang W, Ge M, Wang H. Journal: Int J Surg. 2021 Aug;92:106038. doi: 10.1016/j.ijsu.2021.106038. Epub 2021 Jul 30. PMID: 34339882