J. Sugrue1, S. Eftaiha1, C. Warner1, S. Thomas1, V. Chaudhry1, H. Abcarian1, A. Mellgren1, J. Nordenstam1 1University Of Illinois At Chicago,Colon & Rectal Surgery,Chicago, IL, USA
Introduction:
Sphincter-sparing repairs are commonly used to treat patients with complex cryptoglandular anal fistulas. Despite suboptimal efficacy relative to fistulotomy, they remain appealing because they minimize the risk of postoperative fecal incontinence. The aims of the current study were to evaluate the trends and long-term efficacy of sphincter-sparing fistula operations and determine the risk factors for recurrence.
Methods:
A retrospective review of all patients with cryptoglandular anal fistulas who underwent a sphincter-sparing repair between 2005 and 2015 at a single academic institution was performed. Patients with inflammatory bowel disease were excluded. Patient demographics, comorbidities, fistula characteristics, and type of operation performed were recorded. The primary outcome was the rate of fistula healing without recurrence. The relationship between fistula healing rates and clinical factors reported in this study were analyzed.
Results:
160 patients underwent 223 sphincter-sparing repairs with a median follow-up of 10 months (range 0-120). Overall, 31% healed, 59% recurred, and 10% were lost to follow-up. The median time to fistula recurrence was 3 months (range 0-75). Comparing operations performed between 2005 and 2009 to those performed between 2010 and 2015, there was a significant increase in utilization of the ligation of the intersphincteric fistula tract (LIFT) procedure (p<0.001) and a significant decrease in the utilization of fistula plugs and fibrin glue (p<0.001) though the healing rates were similar: 28% and 34%, respectively (NS) (Figure 1). Patients undergoing a dermal advancement flap (DAF), rectal advancement flap (RAF), or LIFT procedure were less likely to recur compared to patients treated with a fistula plug or fibrin glue (p=0.01). There were no significant differences in healing rates with respect to patient age, gender, BMI, smoking status, comorbidities, use of a draining seton, fistula duration, or history of prior attempts at repair.
Conclusion:
Long-term healing rates following sphincter-sparing repairs of cryptoglandular anal fistulas remain suboptimal despite an increased use of the relatively novel LIFT procedure and decreasing use of fistula plugs and fibrin glue. Patients treated with a RAF, DAF, or LIFT were less likely to recur compared to patients treated with fistula plugs or fibrin glue. No other significant predictors of fistula recurrence were found in this study. Continued studies are needed to discover better techniques in performing sphincter-sparing fistula repairs in order to decrease the rates of recurrence while preserving continence.
