Simple fistula-in-ano: is it all simple? A systematic review

Area of Science:

• Proctology
• Colorectal Surgery

Background:

• Simple anal fistula is a common surgical condition.
• Fistulotomy is the standard treatment but carries risks of complications.

Purpose of the Study:

• To systematically review surgical treatments for simple anal fistula.
• Compare traditional fistulotomy with sphincter-sparing techniques.

Main Methods:

• Literature search of PubMed, Cochrane, and Google Scholar.
• Included observational studies and randomized clinical trials.
• Assessed study quality using Jadad and MINORS scales.

Main Results:

• 66 studies of 4883 patients treated with fistulotomy showed 93.7% healing but 12.7% incontinence.
• 602 patients treated with sphincter-sparing techniques had 77.7% success and no significant incontinence.
• Incontinence and recurrence negatively impacted quality of life.

Conclusions:

• Sphincter-cutting procedures offer high cure rates for anal fistulas but pose a risk of fecal incontinence.
• Sphincter-sparing techniques may be beneficial for specific patient groups.