Analysis of the Factors Affecting Recurrence and Postoperative Incontinence after Surgical Treatment of Anal Fistula: A Retrospective Cohort Study

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Usta M. A.

Turkish Journal of Colorectal Disease, vol.30, pp.275-284, 2020 (Other Refereed National Journals)

  • Publication Type: Article / Article
  • Volume: 30
  • Publication Date: 2020
  • Doi Number: 10.4274/tjcd.galenos.2020.2020-7-7
  • Title of Journal : Turkish Journal of Colorectal Disease
  • Page Numbers: pp.275-284


Aim: Surgical treatment of anal fistula in association with the high rates of recurrence and faecal incontinence is a problematic issue. The complexity of this disease and the diversity of available surgical techniques are the essential factors affecting the outcomes of the treatment. We aimed to assess the rates of recurrence and faecal incontinence as well as the risk factors that affect these outcomes among patients in a single institution. Method: All consecutive patients with cryptoglandular anal fistula who underwent anal fistulotomy or seton placement were retrospectively evaluated during January 2016 and December 2019. The demographic and clinical features, including the Parks’ and St. James’ classifications, the number of surgical procedures, recurrence of fistula and the development and type of faecal incontinence based on the Wexner’s score were evaluated. The recurrence and postoperative incontinence were considered as the primary outcomes of this study. Results: A total of 98 patients of mean age 45.9±13.4 years (male to female ratio: 2.92) were enrolled in this study. Fistulotomy and seton placement were performed in 53 (54.1%) and 45 patients (45.9%), respectively. There were a total of 9 recurrences (9.2%). The age of the patients with recurrence was significantly lower (p=0.044). Postoperative incontinence developed in 11 patients (11.2%). No permanent solid or flatus type of incontinence was noted. No significant impact of the demographic and clinical variables on the development of recurrence and incontinence was noted (p>0.05 for all). For patients with fistulotomy (n=53) and seton placement (n=45), five and 67 extra surgical procedures, respectively, were involved. During the median follow-up time of 33 months, the healing rates after fistulotomy and seton placement were 100%. Conclusion: The recurrence and postoperative incontinence were not influenced by patient, surgery and fistula-related factors. It is therefore feasible to treat anal fistula by using different surgical approaches with acceptable rates of recurrence and incontinence. In fact, a staged surgical approach including serial seton placements followed by fistulotomy may be a reliable technique in appropriate patients. Keywords: Anal fistula, recurrence, faecal incontinence, surgery