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Surgical treatment trends and outcomes for anal fistula: fistulotomy is still accurate and safe. Results from a nationwide observational study

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Abstract

Purpose

The aim of the present study was to analyse current surgical treatment preferences for anal fistula (AF) and its subtypes and nationwide results in terms of success and complications.

Methods

A retrospective multicentre observational cohort study was conducted. The study period was 1 year (2019), with a follow-up period of at least 1 year. A descriptive analysis of patient characteristics and trends regarding technical options was performed. Univariate and multivariate Cox regression models were used to analyse factors associated with healing and faecal incontinence (FI).

Results

Fifty-one hospitals were involved, providing data on 1628 patients with AF. At a median follow-up of 18.3 (9.9–28.3) months, 1231 (75.9%) patients achieved healing, while 390 (24.1%) did not; failure was catalogued as persistence in 279 (17.2.0%) patients and as recurrence in 111 (6.8%). On multivariate analysis, factors associated with healing were fistulotomy (OR 5.5; 95% CI 3.8–7.9; p < 0.001), simple fistula (OR 2.1; 95% CI 1.5–2.8; p < 0.001), single tract (HR 1.9; 95% CI 1.3–2.8; p < 0.001) and number of preparatory surgeries (none vs. 3; HR 1.8; 95% CI 1.2–2.8; p = 0.006). Regarding de novo FI, in the multivariate analysis previous anal surgery (OR 1.5, 95% CI 1.0–2.4, p = 0.037), age (OR 1.02, 95% CI 1.00–1.04, p = 0.002) and being female (OR 1.7, 95% CI 1.1–2.5, p = 0.008) were statistically related.

Conclusions

Anal fistulotomy is the most used procedure for AF, especially for simple AF, with a favourable overall balance between healing and continence impairment. Sphincter-sparing or minimally invasive sphincter-sparing techniques resulted in lower rates of healing. In spite of their intended sphincter-sparing design, a certain degree of FI was observed for several of these techniques.

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Acknowledgements

The members of the collaborative group are Dr. Javier Espinosa Soria, Dr. Jordi Seguí Orejuela, Hospital de Elda (Alicante); Dr. Luis Sánchez-Guillén, Dra. Julia López-Noguera, Dr. Miguel Ángel Pérez, Hospital General Universitario de Elche (Elche, Alicante); Dra. Natalia Gutiérrez Corral, Hospital Universitario de San Agustín (Avilés); Dra. María Carmona Agúndez, Hospital Universitario de Badajoz (Badajoz); Dr. David Saavedra Pérez, Dra. Helga Calvaienen Mejía, Hospital Consorci Sanitari Alt Penedes-Garraf (Barcelona); Dra. Marta Barros Segura, Dr. Gianluca Pellino, Hospital Vall d´Hebron (Barcelona); Dr. Gerardo Rodríguez León, Hospital de Viladecans (Barcelona); Dra. Andrea Jiménez Salido, Hospital Comarcal Alt Penedés (Vilafranca del Penedés); Dra. Tatiana Gómez Sánchez, Dra. Susana Roldán Ortiz, Hospital Puerta del Mar (Cádiz); Dr. Luis Eloy Cantero Gutiérrez, Hospital Comarcal Sierrallana (Torrelavega); Dra. Natalia Suarez Pazos, Dra. Lidia Cristóbal Poch, Hospital Marqués de Valdecilla (Santander); Dr. Juan Ramón Gómez López, Hospital Medina del Campo (Medina del Campo–Valladolid); Dr. Pablo Méndez Sánchez, Hospital General de Valdepeñas (Valdepeñas- Ciudad Real); Dra. Pilar Fernández Veiga, Dra. Victoria Erene Flores Rodríguez, Dr. Óscar Cano Valderrama, Dr. Enrique Moncada Iribarren, Hospital Álvaro Cunqueiro (Vigo, Pontevedra); Dra. Nuria Ortega Torrecilla, Hospital Josep Trueta (Girona); Dr. Alberto Carrillo Acosta, Dra. Cristina Plata Illescas, Dr. Jose Luis Diez Vigil, Hospital Virgen de las Nievas (Granada); Dra. Estefanía Laviano Martínez, Fundación Hospital Calahorra (Calahorra- La Rioja); Dra. María Beltrán Martos, Hospital de León (León); Dr. David Ambrona Zafra, Dra. Silvia Pérez Farré; Hospital Arnau de Vilanova (Lleida); Dr. David Díaz Pérez, Dra. Ana Belén Gallardo Herrera (Hospital de Torrejón (Torrejón de Ardoz–Madrid); Dra. Elena Viejo, Hospital Infanta Leonor (Madrid); Dr. Juan Ocaña Jiménez, Dr. Jordi Núñez Núñez, Hospital Ramón y Cajal (Madrid); Dra. Alba Correa Bonito, Hospital Fundación Alcorcón (Madrid); Dra. Elena Bermejo Marcos, Hospital de la Princesa (Madrid); Dra. Marta González Bocanegra, Dra. Alicia Ferrer Martínez, Hospital de Getafe (Madrid); Dra. Irene Mirón Fernández, Hospital Regional Universitario de Málaga (Málaga); Dra. Elena González Sánchez-Migallón, Dra. María Teresa Solano Palao, Hospital Rafael Méndez de Lorca (Murcia); Dr. Emilio Peña Ros, Hospital General Universitario Reina Sofía (Murcia); Dra. Inés Aldrey Cao, Hospital de Ourense (Ourense); Dra. Carlenny Suero Rodríguez, Dra. Victoria Maderuelo, Complejo Asistencial de Palencia (Palencia); Dra. Aroa Abascal Amo, Hospital de Segovia (Segovia); Dr. Juan Cintas Catena, Hospital Vírgen de la Macarena (Sevilla); Dra. María del Campo La Villa, Hospital Santa Bárbara (Soria); Dra. Mahur Esmaili Ramo, Dr. Javier Broeckhuizen Benítez, Hospital Nuestra Señora de Prado (Talavera de la Reina); Dra. Ana Navarro Barles, Hospital de San Joan de Reus (Tarragona); Dr. Luis Eduardo Pérez Sánchez, Dra. Ana Soto Sánchez, Dra. Nélida Díaz Jiménez, Dra. Ana María Feria González, Hospital Nuestra Señora de la Candelaria (Tenerife); Dra. Estefanía Domenech Pina, Dr. Alejandro Ros Comesaña, Hospital de Torrevieja (Torrevieja); Dra. Zutoia Balciscueta Coltell, Hospital Arnau de Vilanova (Valencia); Dra. Leticia Pérez Santiago, Dra. Luisa Paola Garzón Hernández, Hospital Clínico Universitario de Valencia (Valencia); Dra. Alejandra de Andrés Gómez, Consorcio Hospital General Universitario de Valencia (Valencia); Dr. Jorge Sancho Muriel, Dra. Mónica Millán Scheiding, Dra. Hanna Cholewa, Hospital de La Fé (Valencia); Da. Marina Alarcón Iranzo, Hospital de Sagunto (Valencia); Dra. Ana Fluixá Pelegri, Hospital Francesc de Borja (Gandía); Dra. Tamara Fernández Miguel, Dra. Natalia Ortega Machón, Hospital Galdakao Usansolo (Bilbao); Dra. Natalia Alonso Hernández, Dr. Álvaro García Granero, Hospital Son Espases (Palma de Mallorca); Dra. Tatiana Civeira Taboada, Dr. Yago Rojo Fernández, Hospital Universitario de la Coruña (Coruña); Dr. Jose Aurelio Navas Cuellar, Hospital Universitario de Valme (Sevilla); Dra. Celia Castillo, Dra. Isabel Pascual Miguelañez, Hospital Universitario de la Paz (Madrid); Dra. Sandra Dios Barbeitio, Dra. María Luisa Reyes Díaz, Dra. Ana María García Cabrera, Dra. Irene María Ramallo Solís, Hospital Virgen del Rocío (Sevilla); Dra. Teresa Pérez Pérez, Hospital de Xátiva (Valencia); Dr. Gabriel Marín, Hospital Reina Sofía (Tudela-Navarra); Dra. Aranzazu Calero Lillo, Fundaciò Hospital Sperit Sant (Barcelona).

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Author notes

  1. Ó. Cano‑Valderrama and T. Fernández Miguel contributed equally.

Authors and Affiliations

  1. Hospital Álvaro Cunqueiro, Complejo Hospitalario de Vigo, Pontevedra, Spain

    Ó. Cano‑Valderrama

  2. Hospital Universitario Galdakao-Usansolo, Bizkaia, Spain

    T. Fernández Miguel

  3. Hospital Universitario de La Princesa, Madrid, Spain

    A. Correa Bonito & C. Cerdán‑Santacruz

  4. Hospital Universitario Y Politécnico de La Fe, Valencia, Spain

    J. Sancho Muriel

  5. Hospital Universitario Reina Sofía, Córdoba, Spain

    F. J. Medina Fernández

  6. Hospital Universitario Reina Sofía, Murcia, Spain

    E. Peña Ros

  7. Hospital Universitario Virgen del Rocío, Seville, Spain

    A. M. García Cabrera

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  1. Ó. Cano‑Valderrama
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  7. A. M. García Cabrera
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Consortia

Grupo Joven de la Asociación Española de Coloproctología (GJ-AECP): Grupo de trabajo sobre fístula anal (Collaborative Group)

  • Javier Espinosa Soria
  • , Jordi Seguí Orejuela
  • , Luis Sánchez-Guillén
  • , Julia López-Noguera
  • , Miguel Ángel Pérez
  • , María Carmona Agúndez
  • , David Saavedra Pérez
  • , Helga Calvaienen Mejía
  • , Marta Barros Segura
  • , Gianluca Pellino
  • , Gerardo Rodríguez León
  • , Andrea Jiménez Salido
  • , Tatiana Gómez Sánchez
  • , Susana Roldán Ortiz
  • , Luis Eloy Cantero Gutiérrez
  • , Natalia Suarez Pazos
  • , Lidia Cristóbal Poch
  • , Juan Ramón Gómez López
  • , Pablo Méndez Sánchez
  • , Pilar Fernández Veiga
  • , Victoria Erene Flores Rodríguez
  • , Óscar Cano Valderrama
  • , Enrique Moncada Iribarren
  • , Nuria Ortega Torrecilla
  • , Alberto Carrillo Acosta
  • , Cristina Plata Illescas
  • , Jose Luis Diez Vigil
  • , Estefanía Laviano Martínez
  • , María Beltrán Martos
  • , David Ambrona Zafra
  • , Silvia Pérez Farré
  • , David Díaz Pérez
  • , Ana Belén Gallardo Herrera
  • , Elena Viejo
  • , Juan Ocaña Jiménez
  • , Jordi Núñez Núñez
  • , Alba Correa Bonito
  • , Elena Bermejo Marcos
  • , Marta González Bocanegra
  • , Alicia Ferrer Martínez
  • , Irene Mirón Fernández
  • , Elena González Sánchez-Migallón
  • , María Teresa Solano Palao
  • , Emilio Peña Ros
  • , Inés Aldrey Cao
  • , Carlenny Suero Rodríguez
  • , Victoria Maderuelo
  • , Aroa Abascal Amo
  • , Juan Cintas Catena
  • , María delLa CampoVilla
  • , Mahur Esmaili Ramo
  • , Javier Broeckhuizen Benítez
  • , Ana Navarro Barles
  • , Luis Eduardo Pérez Sánchez
  • , Ana Soto Sánchez
  • , Nélida Díaz Jiménez
  • , Ana María Feria González
  • , Estefanía Domenech Pina
  • , Alejandro Ros Comesaña
  • , Zutoia Balciscueta Coltell
  • , Leticia Pérez Santiago
  • , Luisa Paola Garzón Hernández
  • , Alejandra de Andrés Gómez
  • , Jorge Sancho Muriel
  • , Mónica Millán Scheiding
  • , Hanna Cholewa
  • , Marina Alarcón Iranzo
  • , Ana Fluixá Pelegri
  • , Tamara Fernández Miguel
  • , Natalia Ortega Machón
  • , Natalia Alonso Hernández
  • , Álvaro García Granero
  • , Tatiana Civeira Taboada
  • , Yago Rojo Fernández
  • , Jose Aurelio Navas Cuellar
  • , Celia Castillo
  • , Isabel Pascual Miguelañez
  • , Sandra Dios Barbeitio
  • , María Luisa Reyes Díaz
  • , Ana María García Cabrera
  • , Irene María Ramallo Solís
  • , Teresa Pérez Pérez
  • , Gabriel Marín
  •  & Aranzazu Calero Lillo

Corresponding author

Correspondence to A. Correa Bonito.

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This study was approved by ethical committee from University Hospital de La Princesa.

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The members of the Grupo Joven de la Asociación Española de Coloproctología (GJ-AECP): Grupo de Trabajo Sobre Fístula Anal (collaborative group) are listed in the Acknowledgements section.

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Cano‑Valderrama, Ó., Miguel, T.F., Bonito, A.C. et al. Surgical treatment trends and outcomes for anal fistula: fistulotomy is still accurate and safe. Results from a nationwide observational study. Tech Coloproctol 27, 909–919 (2023). https://doi.org/10.1007/s10151-023-02842-x

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