Long term Outcomes of Surgical Treatment and Anatomical Characteristics of Acute and Chronic Cryptoglandular Anal Fistula Following Surgery

Supoj Laiwattanapaisal

doi:10.64387/tjs.2026.281231

Authors

Supoj Laiwattanapaisal -

DOI:

https://doi.org/10.64387/tjs.2026.281231

Keywords:

anal fistula, recurrence, healing, prognostic factors, anal fistula mapping

Abstract

Background and Objective: Cryptoglandular anal fistula often recurs after surgery, especially with complex anatomy. This study evaluated healing, recurrence, anatomical patterns, and recurrence predictors in patients treated during acute abscess or chronic fistula stages.

Materials and Methods: This retrospective cohort study included 320 adults who underwent anatomy-tailored surgery for cryptoglandular anal fistula at Rayong Hospital (2012–2025). Patients were classified into acute abscess (n=142) or chronic fistula (n=178) groups. Anatomy was assessed via systematic mapping, supplemented by MRI in complex or recurrent cases. Results: Median follow-up was 42 months. The acute group showed a significantly higher healing rate (97.2% vs. 92.1%, p<0.017) and a lower recurrence rate (2.8% vs. 7.9%, p<0.041) than the chronic group. Multivariable Cox regression identified high transsphincteric fistula as the sole independent predictor of recurrence (adjusted HR 23.13, p<0.001). Conclusion: Anatomy-tailored surgery yielded high healing and low recurrence rates, with high transsphincteric anatomy strongly predicting recurrence.

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