CLINICAL AND FUNCTIONAL EVALUATION OF DIFFERENT TECHNIQUES FOR SURGICAL TREATMENT OF ANAL FISTULA

Introduction Anal fistulas are a common clinical condition in coloproctology practice, characterized by the formation of an abnormal communication between the anal canal and the adjacent skin. Despite significant advances in surgical management, this condition remains challenging due to the high recurrence rate and the potential to cause fecal incontinence, which depend, among other factors, on the surgical technique employed.

Objectives To analyze factors associated with postoperative complications and clinical outcomes in patients undergoing fistulotomy, identifying areas for therapeutic improvement to enhance surgical prognosis.

Methods A cross-sectional study with a descriptive, quantitative, and retrospective approach. The population consists of patients who underwent fistulotomies from January 2021 to October 2023, with postoperative follow-up until January 2024.

Results Seventy-four patients were selected, including those who had multiple approaches, either due to recurrence or fistulotomy with seton in multiple surgical stages. Approximately 54.05% (n=40) of the anal fistulas were transsphincteric, 37.83% (n=28) were intrasphincteric, 6.75% (n=5) were suprasphincteric, and 1.35% (n=1) were superficial. All patients underwent surgery, with a single-stage fistulotomy being the most common, performed in 35 patients (47.29%), followed by fistulotomy with seton in 28 patients (37.83%), the LIFT technique in 9 patients (12.16%), punch fistulectomy in 1 patient (1.35%), and myomucosal flap advancement in 1 patient (1.35%), which was used in conjunction with the LIFT technique. During follow-up, 10.81% (n=8) had recurrence. Among those without recurrence (n=66), 6.06% (n=4) had pain, and 19.69% (n=13) presented varying degrees of fecal incontinence, of which 30.76% (n=4) had fistulotomy with seton and 69.23% (n=9) had anal fistulotomy. Patients with postoperative pain underwent anal fistulotomy. Among those with recurrence, 62.5% underwent the LIFT technique.

Conclusion Fecal incontinence complication rates were within expectations for the techniques used. However, there was a high recurrence rate with the LIFT technique, which requires further refinement by the surgical team. Anal fistulotomy and the technique associated with seton remain safe in terms of recurrence and incontinence, but larger studies on sphincter-saving techniques should be considered.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025