Female Trans-Sphincteric Anterior Anal Fistula: Still an Unsolved Problem-Results from a Nationwide Cohort Study

Area of Science:

• Colorectal Surgery
• Gastroenterology
• Surgical Outcomes

Background:

• Female trans-sphincteric anterior anal fistula presents significant surgical challenges due to potential postoperative incontinence.
• Current surgical practices and their efficacy for this specific patient group require analysis.

Purpose of the Study:

• To analyze surgical techniques and outcomes for female patients with trans-sphincteric anterior anal fistulas.
• To evaluate healing rates, persistence, recurrence, and incontinence associated with different surgical approaches.

Main Methods:

• Nationwide retrospective cohort study of female patients operated on for trans-sphincteric anterior anal fistula in 2019.
• Analysis of surgical techniques including fistulotomy, ligation of the inter-sphincteric fistula tract, and advanced flap procedures.
• Primary outcomes measured were healing, persistence, recurrence, and postoperative incontinence rates.

Main Results:

• Fistulotomy was the most common technique (29.5%), followed by ligation (22.3%).
• Overall healing rate was 60.4%, with higher rates for fistulotomy (87.8%) compared to sphincter-preserving techniques (51.8%).
• Protective factors for healing included non-smoking and fistulotomy. Overall incontinence was 12.6%, higher in complex fistulas (25%), with obesity identified as a risk factor.

Conclusions:

• Treatment for female trans-sphincteric anterior anal fistulas remains challenging with diverse surgical options.
• Fistulotomy demonstrates safety and good results for healing and incontinence in low and selected medium fistulas.
• Strict patient selection criteria support fistulotomy as the indicated procedure for specific cases.