Abstract
PURPOSE: The surgical treatment of fistula-in-ano frequently results in recurrence of the fistula or postoperative anal incontinence. Despite these problems, most patients are satisfied with the results of their surgery. To clarify this apparent discrepancy, we attempted to identify factors that affect patient's lifestyles and may contribute to their satisfaction. METHODS: A questionnaire was mailed to 624 patients surgically treated for cryptoglandular fistula-in-ano at the University of Minnesota during a five-year period. Three hundred seventy-five patients returned their questionnaires. Patients who were followed up for a minimum of one year were included in this retrospective study. Associations between postoperative complications and patient satisfaction were identified by chi-squared tests and multiple logistic regression. Attributable fractions for patient dissatisfaction were calculated using study population dissatisfaction rates. RESULTS: Patient satisfaction was strongly associated with fistula recurrence, difficulty holding gas, soiling of undergarment, and accidental bowel movements. Effects of incontinence on patient quality of life were also significantly associated with patient satisfaction as was the number of lifestyle activities affected by incontinence. Patients with fistula recurrence reported a higher dissatisfaction rate (61 percent) than did patients with anal incontinence (24 percent), but the attributable fraction of dissatisfaction for incontinence (84 percent) was greater than that for fistula recurrence (33 percent). Patient satisfaction was not significantly associated with age, gender, history of previous fistula surgery, type of fistula, surgical procedure, time since surgery, or operating surgeon. CONCLUSION: Patient satisfaction after surgical treatment for fistula-in-ano is associated with recurrence of the fistula, the development of anal incontinence, and with the effects of anal incontinence on patient lifestyle. In our series of patients treated mainly with laying open of the fistula tract, patients with fistula recurrence had a higher dissatisfaction rate than did patients with anal incontinence. However, because anal incontinence was more prevalent than fistula recurrence, a higher fraction of dissatisfaction was attributable to anal incontinence.
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References
Seow-Choen F, Nicholls RJ. Anal fistula. Br J Surg 1992;79:197–205.
Ozuner G, Hull TL, Cartmill J, Fazio VW. Long-term analysis of the use of transanal rectal advancement flaps for complicated anorectal/vaginal fistulas. Dis Colon Rectum 1996;39:10–4.
Golub RW, Wise WE Jr, Kerner BA, Khanduju KS, Aguilar PS. Endorectal mucosal advancement flap: the preferred method for complex cryptoglandular fistula-inano. J Gastrointest Surg 1997;1:487–91.
Hamalainen KP, Sainio AP. Cutting seton for anal fistulas: high risk of minor control defects. Dis Colon Rectum 1997;40:1443–7.
García-Aguilar J, Belmonte C, Wong WD, Goldberg SM, Madoff RD. Anal fistula surgery: factors associated with recurrence and incontinence. Dis Colon Rectum 1996;39:723–9.
Lunniss PJ, Kamm MA, Phillips RK. Factors affecting continence after surgery for anal fistula. Br J Surg 1994;81:1382–5.
García-Aguilar J, Belmonte C, Wong WD, Lowry AC, Madoff RD. Openvs. closed sphincterotomy for chronic anal fissure: long-term results. Dis Colon Rectum 1996;39:440–3.
Rothenberger DA. Anal incontinence. In: Cameron J, ed. Current surgical therapy. 3rd ed. Toronto: BC Decker Inc, 1989:185–94.
Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic research: principles and quantitative methods. Belmont: Wadsworth, 1982;159–64.
Dillman DA. Mail and telephone surveys: the total design method. New York: John Wiley and Sons, 1978.
Hennekens CH, Buring JE. Epidemiology in medicine. Boston: Little, Brown, 1987:92–3, 171–2.
Sailer M, Bussen D, Debus ES, Fuchs KH, Thiede A. Quality of life in patients with benign anorectal disorders. Br J Surg 1998;85:1716–9.
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García-Aguilar, J., Davey, C.S., Le, C.T. et al. Patient satisfaction after surgical treatment for fistula-in-ano. Dis Colon Rectum 43, 1206–1212 (2000). https://doi.org/10.1007/BF02237422
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DOI: https://doi.org/10.1007/BF02237422