Patient satisfaction after surgical treatment for fistula-in-ano

PURPOSE: The surgical treatment of fistula-in-ano frequently results in rec urrence of the fistula or postoperative anal incontinence. Despite these pr oblems, most patients are satisfied with the results of their surgery. To c larify this apparent discrepancy, we attempted to identify factors that aff ect patient's lifestyles and may contribute to their satisfaction. METHODS: A questionnaire was mailed to 624 patients surgically treated for cryptogl andular fistula-in-ano at the University of Minnesota during a five-year pe riod. Three hundred seventy-five patients returned their questionnaires. Pa tients who were followed up for a minimum of one year were included in this retrospective study. Associations between postoperative complications and patient satisfaction were identified by chi-squared tests and multiple logi stic regression. Attributable fractions for patient dissatisfaction were ca lculated using study population dissatisfaction rates. RESULTS: Patient sat isfaction was strongly associated with fistula recurrence, difficulty holdi ng gas, soiling of undergarment, and accidental bowel movements. Effects of incontinence on patient quality of life were also significantly associated with patient satisfaction as was the number of lifestyle activities affect ed by incontinence. Patients with fistula recurrence reported a higher diss atisfaction rate (61 percent) than did patients with anal incontinence (24 percent), but the attributable fraction of dissatisfaction for incontinence (84 percent) was greater than that for fistula recurrence (33 percent). Pa tient satisfaction was not significantly associated with age, gender, histo ry of previous fistula surgery, type of fistula, surgical procedure, time s ince surgery, or operating surgeon. CONCLUSION: Patient satisfaction after surgical treatment for fistula-in-ano is associated with recurrence of the fistula, the development of anal incontinence, and with the effects of anal incontinence on patient lifestyle. In our series of patients treated mainl y with laying open of the fistula tract, patients with fistula recurrence h ad a higher dissatisfaction rate than did patients with anal incontinence. However, because anal incontinence was more prevalent than fistula recurren ce, a higher fraction of dissatisfaction was attributable to anal incontine nce.