Horseshoe abscesses and fistulas: how are we doing?

Area of Science:

• Colorectal Surgery
• Anorectal Diseases
• Surgical Outcomes

Background:

• Horseshoe abscesses and fistulae are complex anorectal conditions with various treatment options.
• Long-term outcomes for these conditions are crucial for patient management.

Purpose of the Study:

• To evaluate the long-term results of surgical treatments for horseshoe abscesses and fistulae.
• To identify factors influencing treatment success and patient outcomes.

Main Methods:

• Retrospective review of patients diagnosed with horseshoe abscess/fistula or postanal space abscess/fistula from 1990-2001.
• Long-term follow-up conducted via telephone questionnaire.
• Analysis of surgical interventions, including posterior midline sphincterotomy and endoanal ultrasonography.

Main Results:

• Out of 31 patients, 17 (54.8%) had Crohn disease.
• 60.7% of patients achieved healed perineal disease or asymptomatic controlled disease at a mean follow-up of 49.3 months.
• Posterior midline sphincterotomy was associated with higher rates of asymptomatic patients (P=.047).
• Crohn disease patients required more operations and were more likely to have a stoma (P=.05).

Conclusions:

• Patients with horseshoe abscesses/fistulae often need multiple operations but can achieve reasonable long-term success.
• Posterior midline sphincterotomy may improve symptoms.
• Crohn disease complicates outcomes and may necessitate more interventions and stoma formation.