Purpose

Surgery for anal fistulas can result in devastating complications, including reoperations and fecal incontinence. There is limited contemporary evidence comparing outcomes since the adoption of the ligation of intersphincteric fistula tract procedure into mainstream practice. The purpose of this study is to compare recurrence rates and long-term outcomes of anal fistula following repair.

Methods

Data was collected from the electronic medical records or patient reported outcomes from patients aged 18 or older with a primary or recurrent cryptoglandular anal fistula. Primary outcome was recurrence defined as the identification of at least one fistula os or a high clinical suspicion of anal fistula. Secondary outcomes included fecal incontinence and postoperative quality of life.

Results

A total of 171 patients underwent definitive surgical repairs for their anal fistula. So 66.5% had a simple fistula, and 33.5% had a complex fistula. Of the 171 patients, 12.5% had a recurrence. The recurrence rates were 5.9% for simple fistula and 25.4% for complex fistula. Predictors of recurrence included diabetes mellitus, history of anorectal abscess, complex fistula, and sphincter sparing surgery. LIFT or plug/biologic procedures were both associated with a 50% or greater recurrence rate. No significant differences were found in fecal incontinence or associated quality of life between sphincter sparing or non-sphincter sparing surgical resections.

Conclusion

The study provides insights into the long-term outcomes of surgical repair for anal fistula. We demonstrate that sphincter sparing operations are associated with increased recurrence, meanwhile, non-sphincter sparing surgeries did not increase the risk of fecal incontinence or worsen quality of life.

中文翻译：

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肛瘘手术修复术后复发的预测因素和长期患者报告的结果，回顾性分析

目的

肛瘘手术可能会导致毁灭性的并发症，包括再次手术和大便失禁。自从括约肌间瘘管结扎术进入主流实践以来，比较结果的当代证据有限。本研究的目的是比较肛瘘修复术后的复发率和长期结果。

方法

数据收集自 18 岁或以上原发性或复发性隐腺肛瘘患者的电子病历或患者报告的结果。主要结局是复发，定义为至少发现一个瘘口或临床高度怀疑肛瘘。次要结局包括大便失禁和术后生活质量。

结果

共有 171 名患者接受了肛瘘彻底手术修复。因此，66.5% 的人患有简单的瘘管，33.5% 的人患有复杂的瘘管。 171 名患者中，12.5% 出现复发。单纯性瘘的复发率为5.9%，复杂性瘘的复发率为25.4%。复发的预测因素包括糖尿病、肛门直肠脓肿病史、复杂瘘管和保留括约肌手术。 LIFT 或栓塞/生物手术均与 50% 或更高的复发率相关。保留括约肌和非保留括约肌的手术切除之间，大便失禁或相关生活质量没有显着差异。

结论

该研究为肛瘘手术修复的长期结果提供了见解。我们证明，保留括约肌的手术与复发率增加有关，同时，非保留括约肌的手术不会增加大便失禁的风险或恶化生活质量。