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