Our Summary

This study aims to identify the risk factors that contribute to the recurrence of anal fistula, a painful condition where an abnormal tunnel develops between the skin near the anus and the rectum, after surgery. The researchers conducted a thorough review of global medical literature up to April 2018, excluding any studies involving patients with Crohn’s disease.

From over 3500 research papers, 20 were selected, involving a total of 6168 patients. The study found that the risk of recurrence was higher in cases where the fistula was high in the anal canal, where the internal opening of the fistula could not be identified, and where the fistula had ‘horseshoe’ extensions. The risk was also higher for patients who had previously undergone anal surgery, those who had undergone a particular type of surgery called seton placement, and those with multiple fistula tracts.

However, the study found no significant connection between recurrence and factors such as gender, smoking habits, age, referral to a specialist hospital, alcohol use, diabetes, obesity, the use of a preoperative seton drain (a type of treatment for fistula), the location or type of anal fistula, or certain other surgical procedures.

This research helps doctors identify patients who are at a higher risk of anal fistula recurrence after surgery, allowing them to provide more effective treatment and follow-up care.

FAQs

  1. What are the risk factors that contribute to the recurrence of anal fistula after surgery?
  2. How does the location of the fistula affect the risk of recurrence after surgery?
  3. Does the study find any connection between lifestyle factors such as smoking and alcohol use and the recurrence of anal fistula after surgery?

Doctor’s Tip

In order to reduce the risk of recurrence after anal fistula surgery, it is important for patients to follow their doctor’s post-operative instructions carefully. This may include keeping the area clean and dry, avoiding straining during bowel movements, and maintaining a healthy diet high in fiber to prevent constipation. It is also important to attend all follow-up appointments with your doctor to monitor healing and address any concerns promptly.

Suitable For

Patients who are typically recommended anal fistula surgery are those who have a high anal fistula, where the internal opening of the fistula cannot be identified, or where the fistula has ‘horseshoe’ extensions. Patients who have previously undergone anal surgery, undergone seton placement surgery, or have multiple fistula tracts are also candidates for surgery. It is important for doctors to assess the individual risk factors for each patient to determine the best course of treatment.

Timeline

Timeline before and after anal fistula surgery:

Before surgery:

  1. Patient experiences symptoms such as pain, swelling, discharge, and/or itching around the anus.
  2. Patient visits a doctor who performs a physical examination and possibly orders imaging tests to diagnose the anal fistula.
  3. Patient may undergo conservative treatments such as antibiotics, sitz baths, and drainage of abscesses to manage symptoms.
  4. If conservative treatments are unsuccessful, patient is recommended to undergo surgery to treat the anal fistula.

After surgery:

  1. Patient undergoes surgery to remove the anal fistula and repair the abnormal tunnel.
  2. Patient may experience pain, swelling, and discomfort in the days following surgery.
  3. Patient is prescribed pain medication, antibiotics, and instructed on wound care.
  4. Patient follows up with the surgeon for postoperative appointments to monitor healing and address any complications.
  5. Patient is advised to follow a specific diet and activity restrictions to aid in recovery.
  6. Depending on the type of surgery performed, patient may require multiple follow-up appointments to monitor for recurrence and adjust treatment as needed.

What to Ask Your Doctor

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

  1. What is the success rate of anal fistula surgery?
  2. What are the potential risks and complications associated with the surgery?
  3. How long is the recovery period after the surgery?
  4. Will I need to follow a special diet or make any lifestyle changes after the surgery?
  5. What is the likelihood of the fistula recurring after the surgery?
  6. Are there any specific factors in my case that may increase the risk of recurrence?
  7. What is the recommended follow-up care after the surgery?
  8. Are there any alternative treatments or procedures that could be considered?
  9. How experienced are you in performing anal fistula surgeries?
  10. Are there any specific instructions or precautions I should follow before and after the surgery to ensure the best possible outcome?

Reference

Authors: Mei Z, Wang Q, Zhang Y, Liu P, Ge M, Du P, Yang W, He Y. Journal: Int J Surg. 2019 Sep;69:153-164. doi: 10.1016/j.ijsu.2019.08.003. Epub 2019 Aug 7. PMID: 31400504