Proximal anal sinus resection as an alternative to fistulectomy and seton for reducing recurrence of anal fistulas: a retrospective study.

BACKGROUND

The recurrence rate of anal fistula following classic surgery is a common issue. The purpose of the present study was to compare the recurrence rate of anal fistula following classic surgery (fistulectomy or seton) and proximal anal sinus resection (PASR) in a cohort study.

METHODS

From May 2016 to May 2018, 106 patients who did the anal fistula surgery (classic or PASR) were studied with 2 groups; 74 patients were allocated to the classic surgery group and 32 patients were allocated to the PASR group. Fifty-two patients were excluded because they did not meet the inclusion criteria. We analyzed the recurrence rate of anal fistula, wound healing time, surgical complications, and duration of pain.

RESULTS

Patient characteristics, grouped by surgical approach, showed no significant difference. There was a significant difference in the recurrence rate between the classic surgery group and the PASR group (16.2% vs. 0%, P<0.05). There was no significant difference in the surgical complications in the 2 groups (P>0.05). The mean healing time in the 2 groups was not significantly different; 41.6 days in the classic group (P>0.05) and 40.8 days in the PASR group. Our results also found no significant difference in the duration of pain between the 2 groups; 5.1±1.5 days in the classic group and 5.0±1.0 days in the PASR group (P>0.05).

CONCLUSIONS

PASR was found to have a lower recurrence rate of anal fistula and did not increase the risk of complications. Therefore, PASR should be considered as a first line of treatment for patients at risk of anal fistula recurrence.