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Long-term outcome of low perianal fistulas treated by fistulotomy: a multicenter study

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Fistulotomy is considered to be the golden standard for the treatment of low perianal fistula but might have more influence on continence status than believed. This study was performed to evaluate the healing rate after a fistulotomy and to show results for continence status.

Methods

A retrospective database study was performed in one university medical center and its six affiliated hospitals. All patients treated with a fistulotomy for a low perianal fistula were identified. Healing and recurrence of the fistula were identified. Questionnaires on continence status and quality of life were mailed to all patients.

Results

In total, 537 patients were identified. The primary etiology of the fistulas was cryptoglandular (66.5 %). Recurrence was seen in 88 patients (16.4 %) resulting in a primary healing rate of 83.6 %. After secondary treatment for the recurrence, another 40 patients healed. This resulted in a secondary healing rate of 90.3 %. The Kaplan-Meier analysis showed that at 5 years, the healing rate was 0.81 (95 % confidence interval (95 % CI) 0.71–0.85). The mean Vaizey score was 4.67 (SD 4.80). Major incontinence, defined as a Vaizey score of >6, was seen in 95 (28.0 %) patients. Only 26.3 % of the patients had a perfect continence status (Vaizey score 0). Quality of life was not different from the general population.

Conclusions

Fistulotomy seems to be associated with a healing rate of 0.81 (95 % CI 0.71–0.85) after 5 years. However, major incontinence is still reported by 26.8 % of patients and only 26.3 % of patients had a perfect continence status.

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Author information

Authors and Affiliations

  1. Department of Surgery, Maastricht University Medical Centre, Post Box 5800, 6202 AZ, Maastricht, The Netherlands

    K. W. A. Göttgens, P. T. J. Janssen, L. P. S. Stassen & S. O. Breukink

  2. Department of Surgery, Laurentius Hospital, Roermond, The Netherlands

    J. Heemskerk

  3. Department of Surgery, Maxima Medical Centre, Veldhoven, The Netherlands

    F. M. H. van Dielen

  4. Department of Surgery, VieCuri Medical Centre, Venlo-Venray, The Netherlands

    J. L. M. Konsten

  5. Department of Surgery, St. Jans Gasthuis, Weert, The Netherlands

    T. Lettinga

  6. Department of Surgery, Orbis Medical Centre, Sittard, The Netherlands

    A. G. M. Hoofwijk

  7. Department of Surgery, Atrium Medical Centre, Heerlen, The Netherlands

    H. J. Belgers

Authors
  1. K. W. A. Göttgens
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  2. P. T. J. Janssen
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  3. J. Heemskerk
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  4. F. M. H. van Dielen
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  5. J. L. M. Konsten
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  6. T. Lettinga
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  7. A. G. M. Hoofwijk
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  8. H. J. Belgers
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  9. L. P. S. Stassen
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  10. S. O. Breukink
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Corresponding author

Correspondence to K. W. A. Göttgens.

Additional information

This study was presented and awarded the best abstract at the National Dutch Gastro-enterology Society Conference, March 2014, Veldhoven, The Netherlands.

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Göttgens, K.W.A., Janssen, P.T.J., Heemskerk, J. et al. Long-term outcome of low perianal fistulas treated by fistulotomy: a multicenter study. Int J Colorectal Dis 30, 213–219 (2015). https://doi.org/10.1007/s00384-014-2072-y

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  • DOI: https://doi.org/10.1007/s00384-014-2072-y

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