Fistulotomy with primary sphincteroplasty for complex anal fistulas: Should we be concerned about incontinence?
Complex anal fistulas pose a significant surgical challenge because of high recurrence rates and the risk of fecal incontinence. Fistulotomy with primary sphincteroplasty has been proposed as a single-stage treatment that combines fistula eradication with sphincter reconstruction. However, concerns regarding postoperative continence have limited its widespread adoption. This study aimed to evaluate the long-term clinical and functional outcomes of fistulotomy with primary sphincteroplasty in patients with complex anal fistulas.
A retrospective, single-center cohort study was conducted at the University Hospital of Mersin, Turkey. The study included 382 patients with complex cryptoglandular anal fistulas who underwent fistulotomy with primary sphincteroplasty between January 2013 and January 2023. All procedures were performed by 3 experienced colorectal surgeons using a standardized technique. Primary outcomes were healing rates, recurrence, and continence status assessed by the Wexner score over a mean follow-up of 52.5 months.
The cohort consisted of 277 male (72.5%) and 105 female (27.5%) patients, with a mean age of 42.1 ± 13.7 years. Primary healing after fistulotomy with primary sphincteroplasty was achieved in 91.9% (351 of 382) of patients. Recurrence occurred in 31 patients (8.1%), of whom 19 were successfully treated with redo fistulotomy with primary sphincteroplasty. The final persistent recurrence rate was 3.1% (12 of 382), resulting in an overall success rate of 96.9%. No cases of major fecal incontinence were reported. Minor incontinence was observed in 4.9% of patients. Multivariate analysis identified female gender, diabetes mellitus, active smoking, body mass index >28 kg/m2, and operative time >60 minutes as independent predictors of recurrence.
Fistulotomy with primary sphincteroplasty demonstrates excellent long-term efficacy as a single-stage procedure for complex cryptoglandular anal fistulas, providing durable healing with minimal impact on continence when performed by experienced surgeons.
A retrospective, single-center cohort study was conducted at the University Hospital of Mersin, Turkey. The study included 382 patients with complex cryptoglandular anal fistulas who underwent fistulotomy with primary sphincteroplasty between January 2013 and January 2023. All procedures were performed by 3 experienced colorectal surgeons using a standardized technique. Primary outcomes were healing rates, recurrence, and continence status assessed by the Wexner score over a mean follow-up of 52.5 months.
The cohort consisted of 277 male (72.5%) and 105 female (27.5%) patients, with a mean age of 42.1 ± 13.7 years. Primary healing after fistulotomy with primary sphincteroplasty was achieved in 91.9% (351 of 382) of patients. Recurrence occurred in 31 patients (8.1%), of whom 19 were successfully treated with redo fistulotomy with primary sphincteroplasty. The final persistent recurrence rate was 3.1% (12 of 382), resulting in an overall success rate of 96.9%. No cases of major fecal incontinence were reported. Minor incontinence was observed in 4.9% of patients. Multivariate analysis identified female gender, diabetes mellitus, active smoking, body mass index >28 kg/m2, and operative time >60 minutes as independent predictors of recurrence.
Fistulotomy with primary sphincteroplasty demonstrates excellent long-term efficacy as a single-stage procedure for complex cryptoglandular anal fistulas, providing durable healing with minimal impact on continence when performed by experienced surgeons.
Authors
Ozcan Ozcan, Colak Colak, Turkmenoglu Turkmenoglu, Bozkurt Bozkurt, Benli Benli, Berkesoglu Berkesoglu, Guler Guler, Ertas Ertas
View on Pubmed