Results analysis of anorectal fistula treatment

Severija Pažemeckaitė Results analysis of anorectal fistula treatment Aim of study. To evaluate the treatment results of anorectal fistulas with more than 5 years after the surgery. Objectives. Find out the frequency of sphincter function disorders and their impact on quality of life after the surgery. Find after surgery relapse rate. To find and evaluate factors that are important for disabling the sphincter function and relapse. Materials and methods. Analytical and retrospective analysis of the history of anorectal fistula surgery and the comparison of the data of patients who have had anorectic fistula surgery in 2010- 2013 in the Department of Surgery, Lithuanian University of Health Science Kaunas Clinics. Life quality analysis was performed by interviewing patients. Results. Out of 204 patients selected, 91 (44.83%) patient had fistulotomy, 41 (20.20%) of them had fistulectomy according to Gabriel, 23 (11.33%) – tight seton, 41 (20.20%) – lose seton, 7 (3.45%) – anus plastic by sewing the inner hole. The most common type of fistula was intersphincteric with 83 (41.71%) patients having it, low transphincteric fistula canal observed in 67 patients (33.67%), suprasphincteric – in 32 (16.08%), and extrasphincteric – in 17 (8.54%). Moreover, 5-8 years after the surgery, 14 (8%) patients were observed spotting the clothes, and no such complications were observed for 161 (92%) patient. Fecal incontinence as a complication was reported by 23 patients (13.14%), 11 (6.29%) of which did not keep the gas, 8 (4.57%) had liquid fecal and 4 (2.29%) had hard stools. Using a Wexner scale, 174 patients received an average score of 1.58 ± 3.42 points (0 to 19 points). The extrasphincteric canal is usually associated with a 3.3-point Wexner scale score (p = 0.0013) compared to the intrasphincteric of the fistula canal. The suprasphincteric fistula canal was associated with a 1.75-point higher estimate on the Wexner scale (p = 0.0318). The lose seton was also associated with an average of 1,234 higher Wexner scale scores compared to fistulotomy, however, statistical reliability was not obtained (p = 0.087) Conclusion. After AF surgery, frequency of sphincter function disorders is 8% and for fecal incontinence - 13.14% (of which 6.29% of gas, 4.57% of liquid fecal and 2.29% of stools). The extrasphincter fistula canal is associated with a 3.3-point higher Wexner scale score (p = 0.0013) compared to the intrasphincter fistula canal. The relapse frequency is 22.9%. Age had the greatest influence on fecal incontinence - with each year the odds ratio of not keeping the stools increased by 6% (p = 0.026)