84 - Freie Mitteilung
17. Mai 2019, 08:15 - 09:45, Bellavista 5, 6. OG


Longterm outcome of anal fistula - A retrospective study
C. Andreou1, J. Zeindler1, D. Oertli1, H. Misteli2, Presenter: C. Andreou1 (1Basel, 2Uster)

This retrospective observational study analyses the outcomes of patients who underwent surgery for anal fistula at a single center
During a time period of 9 years (01/2005-05/2013) all patients with anal fistula were included. Baseline characteristics, details of presentation, fistula anatomy, type of surgery, post-surgical outcomes and follow-up data were collected. Exclusion criteria were chronic inflammatory bowel disease and previous operation of anal or rectal cancer. The primary endpoints were long-term closure rate and recurrence rate (RR) after 2 years. Secondary endpoints were persistent pain after 2 years, postoperative complications and continence status
A total of 65 patients (52 males, 13 females) with a mean age of 49.7 years were included. The total amount of analyzed operations was 93 which were performed in 78 fistulae. Seventy percent of the performed operations were fistulotomies (n=65), 14% mucosal advancement flaps (n=13), 8% anal fistula plugs (n=7) and 8% cutting-setons (n=8). The mean follow up was 80.5 months. Healing was achieved in 84% with a total RR of 16% (n=15). The highest RR was seen in anal fistula plug with 57%. No recurrence was observed in the total of 8 cutting-seton procedures. For mucosal advancement flap the RR was 23% and for fistulotomy 12%. Detailed analyses of fistulotomy patients show different RR in high fistulae with 28%, comparing to low fistulae with a RR of 6%. Furthermore, 80% of the recurrent high fistulae were not previously treated with a seton. Postoperative infection with abscess but without progression into a recurrent fistula, was seen in 7 of the 65 fistulotomies (complication rate of 11%). For all the different procedures there was no persistent postoperative pain nor incontinence in the long-term follow up
Despite of all the new innovative and minimal invasive operations for the treatment of anal fistula, the healing rate does not show similar results when compared with traditional techniques. In addition, even though the use of cutting-seton is discussed as an outdated technique, the right use in respect of its limitations can be a helpful and easy operation with good results even for the feared complication of incontinence. Further trials are needed to elucidate the efficacy and potential benefit of each technique available in anal fistula treatment
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