Knowledge structure and paradigm evolution in anal fistula diagnosis and treatment: a bibliometric analysis based on...

Anal fistula poses a significant clinical challenge with escalating research interest reflected by a more than 50-fold increase in publications from 2006 to 2026. This bibliometric study systematically analyzed 505 PubMed-indexed articles to elucidate the evolving knowledge structure and research paradigms in anal fistula diagnosis and treatment. Utilizing advanced visualization and clustering techniques via the R bibliometrix package, the analysis mapped global publication trends, geographic and institutional contributions, collaboration networks, journal impact, author influence, and keyword evolution. Results identified China and the United States as leading contributors with distinct international collaboration clusters, while Korean institutions demonstrated notable productivity and specialized research focuses. Key journals such as Diseases of the Colon & Rectum concentrated the majority of domain-specific publications, predominantly within moderate impact factor tiers. Authorship networks revealed diverse, multinational collaborative clusters emphasizing both traditional surgical and emerging minimally invasive approaches. Keyword co-occurrence and citation analyses indicated a thematic shift from basic pathophysiology and surgical techniques toward patient-centered outcomes, quality of life assessments, and prospective study designs. These findings highlight the field's transition toward precision medicine and interdisciplinary integration, underscoring the importance of evidence-based clinical decision-making and international cooperation. This comprehensive bibliometric mapping offers valuable insights to guide future research priorities, foster collaborative innovation, and improve therapeutic strategies aimed at enhancing patient outcomes in anal fistula management.