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Sphincter-Preserving Fistula Management: What Patients Want

Ellis, C. Neal M.D.

doi: 10.1007/DCR.0b013e3181f2e9cd
Original Contribution

PURPOSE: The purpose of this study was to determine how patients with anal fistulas would rank clinical scenarios describing various management options for anal fistulas.

METHOD: A survey was administered to 74 consecutive patients with anal fistulas. On each survey, 10 clinical scenarios describing various treatment options for anal fistulas were scored from 1 (most likely to select) to 10 (least likely to select). Mean scores for each scenario were calculated and compared by use of a Student t test.

RESULTS: When combined, 74% of patients selected a sphincter-preserving technique as their primary choice compared with 26% who chose a fistulotomy (P < .0001). Compared with the highest ranking sphincter-preserving techniques, the mean scores of the scenarios involving a fistulotomy were significantly (P < .05) lower (less likely to select). The mean score of a traditional fistulotomy was the same as the mean score of a sphincter-preserving technique with a 50% success rate but no risk of diminished continence.

CONCLUSIONS: These data suggest that the majority of patients with an anal fistula will select a sphincter-preserving technique to manage their fistula. This finding may indicate that, within limits, it is of greater importance for most patients to minimize their risk of diminished continence than to have a highly successful treatment strategy for their fistula.

Department of Surgery, West Penn Allegheny Health System, Pittsburgh, Pennsylvania

Financial Disclosures: Dr Ellis is a consultant for and has received a research grant from Cook Surgical Inc., he is a consultant for Ethicon Inc., and he has received research grants from Lifecell Inc. and Gore and Assoc.

Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Minneapolis, MN, May 15 to 19, 2010.

Correspondence: C. Neal Ellis, M.D., Department of Surgery, West Penn Allegheny Health System, Pittsburgh, PA 15212. E-mail:

© The ASCRS 2010