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

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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.

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Availability of data and materials

The datasets generated and analyzed during the current study are not publicly available; however, the data can be shared for research and authentication purposes upon reasonable request.

Disclaimer

The full article was not posted or published elsewhere.

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Acknowledgements

The authors would like to thank all the patients in this study.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Shahid Beheshti University of Medical Science, Tehran, Iran

    Fakhrosadat Anaraki, Mohammad Reza Nikshoar & Mehdi Tavallaei

  2. Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran

    Arsh Haj Mohamad Ebrahim Ketabforoush

  3. Metabolic Liver Disease Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

    Rojin Chegini

  4. Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Nasrin Borumandnia

Authors
  1. Fakhrosadat Anaraki
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  2. Mohammad Reza Nikshoar
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  4. Rojin Chegini
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  5. Nasrin Borumandnia
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Contributions

FA, MN, and MT conceived the study and participated in study design, data collection, and data analysis. AHMEK, RC, and MT wrote the manuscript. AHMEK, RC, and MB participated in data collection and data analysis. AHMEK, RC, MT, FA, MN, and MB assisted with preparing the document and interpreting the results. All the authors have read and approved the final submitted manuscript.

Corresponding author

Correspondence to Mehdi Tavallaei.

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Conflict of interest

The authors have no conflicts of interest to declare that they are relevant to the content of this article.

Ethical approval

The Ethics Committee of Shahid Beheshti University of Medical Sciences approved this study (Approval ID: IR.SBMU.RETECH.REC.1400.878).

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Written informed consent was obtained from the patients.

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Anaraki, F., Nikshoar, M., Ketabforoush, A.H.M.E. et al. Fistulectomy and primary sphincteroplasty in complex anal fistula treatment: a hospital-based long-term follow-up study. Tech Coloproctol 27, 145–152 (2023). https://doi.org/10.1007/s10151-022-02722-w

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