ANAL FISTULA SURGERY - FACTORS ASSOCIATED WITH RECURRENCE AND INCONTINENCE

PURPOSE: This study was undertaken to assess results of surgery for fi stula-in-ano and identify risk factors for fistula recurrence and impa ired continence. METHODS: We reviewed the records of 624 patients who underwent surgery for fistula-in-ano between 1988 and 1992. Follow-up was by mailed questionnaire, with 375 patients (60 percent) responding . Mean follow-up was 29 months. Fistulas were intersphincteric in 180 patients, transsphincteric in 108, suprasphincteric in 6, extrasphinct eric in 6, and unclassified in 75. Procedures included fistulotomy and marsupialization (n = 300), seton placement (n = 63), endorectal adva ncement flap (n = 3), and other (n = 3). Factors associated with recur rence and incontinence were analyzed by univariate and multivariate re gression analysis. RESULTS. The fistula recurred in 31 patients (8 per cent), and 45 percent complained of some degree of postoperative incon tinence. Factors associated with recurrence included complex type of f istula, horseshoe extension, lack of identification or lateral locatio n of the internal fistulous opening, previous fistula surgery, and the surgeon performing the procedure. Incontinence was associated with fe male sex, high anal fistula, type of surgery, and previous fistula sur gery. CONCLUSIONS: Surgical treatment of fistula-in-ano is associated with a significant risk of recurrence and a high risk of impaired cont inence. Degree of risk varies with identifiable factors.