Fistulectomy and primary sphincteroplasty in complex anal fistula treatment: a hospital-based long-term follow-up study

Fakhrosadat Anaraki; Mohammad Reza Nikshoar; Arsh Haj Mohamad Ebrahim Ketabforoush; Rojin Chegini; Nasrin Borumandnia; Mehdi Tavallaei

doi:10.1007/s10151-022-02722-w

Fistulectomy and primary sphincteroplasty in complex anal fistula treatment: a hospital-based long-term follow-up study

Tech Coloproctol. 2023 Feb;27(2):145-152. doi: 10.1007/s10151-022-02722-w. Epub 2022 Nov 13.

Authors

Fakhrosadat Anaraki¹, Mohammad Reza Nikshoar¹, Arsh Haj Mohamad Ebrahim Ketabforoush², Rojin Chegini³, Nasrin Borumandnia⁴, Mehdi Tavallaei⁵

Affiliations

¹ Department of Colorectal Surgery, Shahid Beheshti University of Medical Science, Tehran, Iran.
² Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran.
³ Metabolic Liver Disease Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
⁴ Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁵ Department of Colorectal Surgery, Shahid Beheshti University of Medical Science, Tehran, Iran. Mohsentavallae@yahoo.com.

PMID: 36371771
DOI: 10.1007/s10151-022-02722-w

Abstract

Background: Currently, there is no agreement on the best treatment for complex anal fistulas with the least recurrence and lowest complication rate. The aim of this study was to evaluate the long-term recurrence and incontinence after fistulectomy and primary sphincteroplasty (FIPS) in a group of patients with complex perianal fistula.

Methods: This prospective observational study was done at the colorectal ward of Taleghani Hospital of Tehran from January 2010 to December 2020. Patients with anal fistula who underwent FIPS were studied. After surgery, patients were evaluated regularly by a colorectal surgeon for fistula recurrence and incontinence. Recurrence was described as a new fistula tract formation after the initial cure and failure of healing in the operation site or any purulent discharge from the fistula tract and openings. In addition, the patient's continence was assessed based on the Wexner score.

Results: There were 335 patients (66 men and 269 women, mean age 42.74 ± 12.44 years), 191 of them with low fistula and 144 with high fistula. Thirteen patients (3.90%) experienced recurrence (all had a low fistula). Thirty-nine patients (11.64%), 19 patients with high and 20 patients with low fistula, had a Wexner score ≥ 3 during the follow-up. Fifteen patients were lost to follow-up. Male patients (OR = 2.67, 95% CI 0.84, 8.45, p = 0.094, adjusted OR = 4.41, 95% CI 1.05, 18.48, p = 0.042), patients with low fistula (p = 0.001), and recurrent cases had a significantly higher rate of recurrence (OR = 10.38, 95% CI 3.24-33.20 p ≤ 0.001, adjusted OR = 23.36, 95% CI 4.35-125.39, p ≤ 0.001). A significant correlation between body mass index > 35 kg/m² and incontinence was found (OR = 4.40, 95% CI 1.35, 14.33, p = 0.014).

Conclusions: In the present study, an acceptable healing rate and a low percentage of complications following FIPS were seen in patients with complex anal fistula. Randomized clinical trials with appropriate follow-up duration and sample size comparing different surgical methods in these patients are needed to confirm these results.

Keywords: Complex fistula; FIPS; Fistulectomy; Perianal fistula; Sphincteroplasty.

Publication types

Observational Study

MeSH terms

Adult
Anal Canal / surgery
Colorectal Neoplasms* / complications
Fecal Incontinence* / complications
Fecal Incontinence* / surgery
Female
Follow-Up Studies
Humans
Iran
Male
Middle Aged
Rectal Fistula* / complications
Rectal Fistula* / surgery
Recurrence
Treatment Outcome
Urinary Incontinence*