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Outcomes After Fistulotomy: Results of a Prospective, Multicenter Regional Study

Hyman, Neil M.D.; O’Brien, Sean M.A.; Osler, Turner M.D.

doi: 10.1007/DCR.0b013e3181b72378
Original Contribution

PURPOSE: This study aimed to determine the outcomes and healing rate after fistula surgery across a broad spectrum of colorectal practices.

METHODS: A prospective, multicenter outcomes registry was created by the New England Regional Chapter of The American Society of Colon and Rectal Surgeons. All consecutive patients undergoing surgical treatment of an anal fistula by a participating surgeon from October 1, 2007 to September 30, 2008, were entered. Demographics, fistula characteristics including Parks’ classification, smoking history, previous vaginal deliveries, diagnosis of Crohn’s disease, Fecal Incontinence Severity Index, and operations performed were noted. A follow-up datasheet recorded postoperative complications, healing at one and three months, and postoperative continence scores. Factors associated with healing and treatment success were compared by use of Fisher’s exact test.

RESULTS: Twenty-five surgeons at 13 hospitals entered 245 patients (162 male, 83 female) in the registry. Seventy-five patients had recurrent fistulas, 51 had multiple tracts, 62 were smokers, and 24 had Crohn’s disease. The overall healing rate was 19.5% at one month and 63.2% at three months. Female gender (P = 0.04) and recurrent fistula (P = 0.03) were associated with nonhealing, and 28.4% of patients required additional surgery. The best healing rate was associated with fistulotomy (87%), whereas a plug had the worst healing rate (32%, P = 0.001).

CONCLUSIONS: Surgical treatment of an anal fistula is associated with a substantial risk of nonhealing at three months. Fistulotomy had a high success rate, whereas the bioprosthetic plug had the lowest success rate. Multicenter studies comparing treatment options for similar fistulas are needed.

Department of Surgery, University of Vermont, Burlington, Vermont

Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Hollywood, Florida, May 2 to 6, 2009.

Address of correspondence: Neil Hyman, M.D., University of Vermont, Department of Surgery, 111 Colchester Avenue, Burlington, Vermont 05401. E-mail:

See Appendixes A to C on pages 2026 to 2027.

© The ASCRS 2009