Types of Fistula in Ano and Postoperative Outcomes at Maharat Nakhon Ratchasima Hospital
Keywords:
fistula in ano, type of fistula, recurrenceAbstract
Background: A fistula in ano is an abnormal tract or cavity communicating with the rectum or anal canal byidentifiable internal opening. Recurrent rates after treatment may approach 25%.
Objective: To assess the relative prevalence of each type of fistula in ano, describe intraoperative findings and
determine recurrence rate.
Patients and methods: Fistula in ano patients who underwent operation from 1 January 2009 to 31 July 2010 at
Maharat Nakhon Ratchasima Hospital were prospectively studied.
Results: There were 120 patients (101 men, 19 women), aged between 2 to 87 years (mean age 42.4 years). Fistulain-
ano was simple in 84 patients (70%) and complex in 36 patients (30%). Among the complex fistula in ano patients
were those with high transphincteric fistula in 9 cases (25%), extrasphincteric in 1 case (2.8%), anterior fistula in the
female in 7 cases (19.4%), coexistent with inflammatory bowel disease in 5 cases (13.9%), with multiple simultaneous
fistula in 10 cases (27.8%), and had prior sphincter surgeries or injuries in 4 cases (11.1%). Fistulotomy was done in
75 cases (62.5%), core out fistulectomy in 28 cases (23.3%), seton drainage in 16 cases (13.3%), advancement flap in
1 case (0.9%). Overall recurrence was 15% (18 cases). Recurrent rates were 41.7% (15 cases) in the complex fistula in
ano group and 3.6% (3 cases) in the simple fistula in ano group, which were significantly different (P <0.05).
Conclusion: Simple fistula in ano was found in 70% and complex fistula in 30% of patients. Overall recurrence
rate was 15%; for the complex fistula group the recurrence was 41.7%, which was significantly different from the simple
fistula group (3.6%).
References
1. Abbas MA, Lemus-Rangel R, Hamadani A. Long-term outcome
of endorectal advancement flap for complex anorectal
fistulae. Am Surg 2008;74:921-4.
2. Rojanasakul A, Pattana-arun J, Sahakitrungruang C,
Tantiphlachiva K. Total anal sphincter saving technique for
fistula-in-ano; the ligation of intersphincteric fistula tract. J
Med Assoc Thai 2007;90:581-6.
3. Lilius HG. Fistula-in-ano, an investigation of human foetal anal
ducts and intramuscular glands and a clinical study of 150
patients. Acta Chir Scand Suppl 1969;383:7-88.
4. The Standards Practice Task Force of the American Society of
Colon and Rectal Surgeons. Practice parameters for treatment
of fistula-in-ano supporting documentation. Dis Colon Rectum
1996;39:1363-72.
5. Seow-Choen F, Nicholls FJ. Anal fistula. Br J Surg 1992;79:197-
205.
6. Parks AG, Gordon PH, Hardcastle JD. A classification of fistulain-
ano. Br J Surg 1976;63:1-12.
7. Goldberg SM, Garcia-Aguilar J. The cutting seton. In: Phillips
RKS, Lunniss PJ, editors. Anal Fistula. London: Chapman & Hall
Medical; 1996. p. 95-102.
8. Gurer A, Ozlem N, Gokakin AK, Ozdogan M, Kulacoglu H,
Aydin R. A novel material in seton treatment of fistula-in-ano.
Am J Surg 2007;193:794-6.
9. Deeba S, Aziz O, Sains PS, Darzi A. Fistula-in-ano: advances in
treatment. Am J Surg 2008;196:95-9.
10. Sileri P, Cadeddu F, D’Ugo S, et al. Surgery for fistula-in-ano in
a specialist colorectal unit: a critical appraisal. BMC
Gastroenterol 2011;11:111-20.
11. Abcarian H, Dodi G, Gironi J, et al. Fistula-in-ano. Int J Colorect
Dis 1987;2:51-71.
12. Christensen A, Nilas L, Christiansen J. Treatment of transphincteric
anal fistulas by the seton technique. Dis Colon Rectum
1986;29:454-5.
13. Chung W, Kazemi P, Ko D, et al. Anal fistula plug and fibrin glue
versus conventional treatment in repair of complex anal
fistulas. Am J Surg 2009;197:604-8.
14. KyAJ, Sylla P, Steinhagen R, Steingagen E, Khaitov S, Ly EK.
Collagen fistula plug for the treatment of anal fistulas. Dis
Colon Rectum 2008;51:838-43.
15. Mitalas LE, Gosselink MP, Oom DM, Zimmermen DD, Schouten
WR. Required length of follow-up after transanal advancement
flap repair of high transsphincteric fistulas. Colorectal Dis
2009;11:726-8.
16. Sygut A, Zajdel R, Kedzia-Budziewska R, Trzcinski R, Dziki A. Late
results of treatment of anal fistulas. Colorectal Dis 2007;9:151-
8.
17. Whiteford MH, Kilkenny J 3rd, Hyman N, et al. Practice
parameters for the treatment of perianal abscess and fistulain-
ano(revised). Dis Colon Rectum 2005;48:1337-42.
18. Cox SW, Senagore AJ, Luchtefeld MA, Mazier WP. Outcome
after incision and drainage with fistulotomy for ischiorectal
abscess. Am Surg 1997;63:686-9.
19. Ho YH, Tan M, Leong AF, Seow-Choen F. Marsupialization of
fistulotomy wounds improves healing: a randomized controlled
trial. Br J Surg 1998;85:105-7.
20. Garcia-Aguilar J, Belmonte C, Wong WD, Goldberg SM, Madoff
RD. Anal fistula surgery. Factors associated with recurrence
and incontinence. Dis Colon Rectum 1996;39:723-9.
21. Hammond TM, Knowles GH, Porrett T, Lunniss PJ. The Sung
Seton: short and medium term results of slow fistulotomy for
idiopathic anal fistulae. Colorectal Dis 2006;8:328-37.
of endorectal advancement flap for complex anorectal
fistulae. Am Surg 2008;74:921-4.
2. Rojanasakul A, Pattana-arun J, Sahakitrungruang C,
Tantiphlachiva K. Total anal sphincter saving technique for
fistula-in-ano; the ligation of intersphincteric fistula tract. J
Med Assoc Thai 2007;90:581-6.
3. Lilius HG. Fistula-in-ano, an investigation of human foetal anal
ducts and intramuscular glands and a clinical study of 150
patients. Acta Chir Scand Suppl 1969;383:7-88.
4. The Standards Practice Task Force of the American Society of
Colon and Rectal Surgeons. Practice parameters for treatment
of fistula-in-ano supporting documentation. Dis Colon Rectum
1996;39:1363-72.
5. Seow-Choen F, Nicholls FJ. Anal fistula. Br J Surg 1992;79:197-
205.
6. Parks AG, Gordon PH, Hardcastle JD. A classification of fistulain-
ano. Br J Surg 1976;63:1-12.
7. Goldberg SM, Garcia-Aguilar J. The cutting seton. In: Phillips
RKS, Lunniss PJ, editors. Anal Fistula. London: Chapman & Hall
Medical; 1996. p. 95-102.
8. Gurer A, Ozlem N, Gokakin AK, Ozdogan M, Kulacoglu H,
Aydin R. A novel material in seton treatment of fistula-in-ano.
Am J Surg 2007;193:794-6.
9. Deeba S, Aziz O, Sains PS, Darzi A. Fistula-in-ano: advances in
treatment. Am J Surg 2008;196:95-9.
10. Sileri P, Cadeddu F, D’Ugo S, et al. Surgery for fistula-in-ano in
a specialist colorectal unit: a critical appraisal. BMC
Gastroenterol 2011;11:111-20.
11. Abcarian H, Dodi G, Gironi J, et al. Fistula-in-ano. Int J Colorect
Dis 1987;2:51-71.
12. Christensen A, Nilas L, Christiansen J. Treatment of transphincteric
anal fistulas by the seton technique. Dis Colon Rectum
1986;29:454-5.
13. Chung W, Kazemi P, Ko D, et al. Anal fistula plug and fibrin glue
versus conventional treatment in repair of complex anal
fistulas. Am J Surg 2009;197:604-8.
14. KyAJ, Sylla P, Steinhagen R, Steingagen E, Khaitov S, Ly EK.
Collagen fistula plug for the treatment of anal fistulas. Dis
Colon Rectum 2008;51:838-43.
15. Mitalas LE, Gosselink MP, Oom DM, Zimmermen DD, Schouten
WR. Required length of follow-up after transanal advancement
flap repair of high transsphincteric fistulas. Colorectal Dis
2009;11:726-8.
16. Sygut A, Zajdel R, Kedzia-Budziewska R, Trzcinski R, Dziki A. Late
results of treatment of anal fistulas. Colorectal Dis 2007;9:151-
8.
17. Whiteford MH, Kilkenny J 3rd, Hyman N, et al. Practice
parameters for the treatment of perianal abscess and fistulain-
ano(revised). Dis Colon Rectum 2005;48:1337-42.
18. Cox SW, Senagore AJ, Luchtefeld MA, Mazier WP. Outcome
after incision and drainage with fistulotomy for ischiorectal
abscess. Am Surg 1997;63:686-9.
19. Ho YH, Tan M, Leong AF, Seow-Choen F. Marsupialization of
fistulotomy wounds improves healing: a randomized controlled
trial. Br J Surg 1998;85:105-7.
20. Garcia-Aguilar J, Belmonte C, Wong WD, Goldberg SM, Madoff
RD. Anal fistula surgery. Factors associated with recurrence
and incontinence. Dis Colon Rectum 1996;39:723-9.
21. Hammond TM, Knowles GH, Porrett T, Lunniss PJ. The Sung
Seton: short and medium term results of slow fistulotomy for
idiopathic anal fistulae. Colorectal Dis 2006;8:328-37.
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Published
2014-03-31
How to Cite
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Santichatngam P, Chumnanua Y. Types of Fistula in Ano and Postoperative Outcomes at Maharat Nakhon Ratchasima Hospital. Thai J Surg [Internet]. 2014 Mar. 31 [cited 2024 Nov. 22];35(1). Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/226365
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