The value of routine histopathological analysis in patients with fistula in-ano

To determine the positive yield of routine histopathology in patients undergoing surgery for fistula in-ano.

Histopathology reports of all the patients who underwent surgery for fistulae-in-ano over a period of 36 months were reviewed.

Analysis included 84 patients of which 73 (87%) were male subjects. The mean age was 39.4 years (range 11-68). Forty-one (49%) had recurrent fistulae. Granulomatous diseases such as Crohn's disease and tuberculosis (TB) were suspected in six patients. However, of the six patients, confirmation of the disease status was obtained only in three patients: stains for acid-fast bacilli confirmed TB in two (2.4%) patients and colonoscopy and biopsy confirmed Crohn's disease in one (1.2%) patient. All three patients had recurrent fistulae.

As the positive yield of routine histopathology is minimal, we do not recommend routine histopathology for fistula in-ano, except for those presenting with recurrent fistulae and those with clinical suspicion of an underlying disease such as TB, HIV or Crohn's disease.