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Outcomes After Operations for Anal Fistula: Results of a Prospective, Multicenter, Regional Study

Hall, Jason F. M.D., M.P.H.1; Bordeianou, Liliana M.D., M.P.H.2; Hyman, Neil M.D.3; Read, Thomas M.D.1; Bartus, Christine M.D.4; Schoetz, David M.D.1; Marcello, Peter W. M.D.1

doi: 10.1097/DCR.0000000000000216
Original Contributions: Anorectal Disease

BACKGROUND: There are various surgical techniques used treat anal fistulas. The adoption and success rates of newer techniques have not been clearly established.

OBJECTIVE: The purpose of this study was to determine the healing rate after operations for anal fistulas in New England colorectal surgery practices.

DESIGN: We conducted a retrospective review of a prospectively collected database.

SETTINGS: The study was conducted at colorectal surgery practices in New England.

PATIENTS: A prospective, multicenter registry was created by the New England Society of Colon and Rectal Surgeons. Surgeons were invited to collect data prospectively regarding patients operated on for anal fistulas between January 1, 2011, and August 1, 2013. Fistula classification, surgical intervention, continence scores, and healing were determined by the treating surgeon.

INTERVENTION: Operation for anal fistula was performed.

MAIN OUTCOME MEASURES: We measured the proportion of patients with healed fistulas at 3 months.

RESULTS: Sixteen surgeons submitted data regarding 240 operations for fistula with curative intent. Mean patient age was 45 ± 14 years. A total of 158 patients (66%) were men, and 110 (46%) had undergone an anorectal operation. Twenty-nine (12%) had Crohn’s disease. The healing rates of fistulotomy, advancement flap, and fistula plugs at 3 months were 94% (95% CI, 89–97), 60% (95% CI, 33–77), and 20% (95% CI, 5–50). The healing rate of the ligation of intersphincteric fistula tract procedure at 3 months was 79% (95% CI, 65–88). Hospital site was the only variable associated with healing (p < 0.05). Hospitals that performed more ligation of intersphincteric fistula tract procedures had higher healing rates at 3 months (p < 0.0001).

LIMITATIONS: This study was limited by selection bias and reporting bias.

CONCLUSIONS: A wide variety of techniques are used to treat anal fistulas in our region. Fistulotomy continues to have excellent results. There has been enthusiastic early adoption of the ligation of intersphincteric fistula tract technique. Early healing rates after the ligation of intersphincteric fistula tract procedure appear to be excellent.

1Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts

2Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts

3Department of Surgery, University of Vermont College of Medicine, Burlington, Vermont

4Department of Surgery, Hartford Healthcare Medical Group, Farmington, Connecticut

Financial Disclosure: None reported.

Podium presentation at the meeting of The American Society of Colon and Rectal Surgeons, Hollywood, FL, May 17 to 21, 2014.

Correspondence: Jason F. Hall, M.D., M.P.H., Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, MA 01805. E-mail:

© 2014 The American Society of Colon and Rectal Surgeons