Article ; Online: FISSIT (Fistula Surgery in Italy) study: A retrospective survey on the surgical management of anal fistulas in Italy over the last 15 years.
2021 Volume 170, Issue 3, Page(s) 689–695
Abstract: Background: Surgical treatment of anal fistulas is still a challenge. The aims of this study were to evaluate the adoption and healing rates for the different surgical techniques used in Italy over the past 15 years.: Methods: This was a multicenter ... ...
| Abstract | Background: Surgical treatment of anal fistulas is still a challenge. The aims of this study were to evaluate the adoption and healing rates for the different surgical techniques used in Italy over the past 15 years. Methods: This was a multicenter retrospective observational study of patients affected by simple and complex anal fistulas of cryptoglandular origin who were surgically treated in the period 2003-2017. Surgical techniques were grouped as sphincter-cutting or sphincter-sparing and as technology-assisted or techno-free. All patients included in the study were followed for at least 12 months. Results: A total of 9,536 patients (5,520 simple; 4,016 complex fistulas) entered the study. For simple fistulas, fistulotomy was the most frequently used procedure, although its adoption significantly decreased over the years (P < .0005), with an increase in sphincter-sparing approaches; the overall healing rate in simple fistulas was 81.1%, with a significant difference between sphincter-cutting (91.9%) and sphincter-sparing (65.1%) techniques (P = .001). For complex fistulas, the adoption of sphincter-cutting approaches decreased, while sphincter-sparing techniques were mildly preferred (P < .0005). Moreover, there was a significant trend toward the use of technology-assisted procedures. The overall healing rate for complex fistulas was 69.0%, with a measurable difference between sphincter-cutting (81.1%) and sphincter-sparing (61.4%; P = .001) techniques and between techno-free and technology-assisted techniques (72.5% and 55.0%, respectively; P = .001). Conclusion: Surgical treatment of anal fistulas has changed, with a trend toward the use of sphincter-sparing techniques. The overall cure rate has remained stable, even if the most innovative procedures have achieved a lower success rate. |
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| MeSH term(s) | Anal Canal/surgery ; Fecal Incontinence/epidemiology ; Fecal Incontinence/etiology ; Female ; Follow-Up Studies ; Forecasting ; Humans ; Incidence ; Italy/epidemiology ; Male ; Middle Aged ; Population Surveillance/methods ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Rectal Fistula/complications ; Rectal Fistula/epidemiology ; Rectal Fistula/surgery ; Retrospective Studies |
| Language | English |
| Publishing date | 2021-04-10 |
| Publishing country | United States |
| Document type | Journal Article ; Multicenter Study ; Observational Study |
| ZDB-ID | 202467-6 |
| ISSN | 1532-7361 ; 0039-6060 |
| ISSN (online) | 1532-7361 |
| ISSN | 0039-6060 |
| DOI | 10.1016/j.surg.2021.02.055 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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