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Contemporary surgical practice in the management of anal fistula: results from an international survey.

Abstract：

BACKGROUND:Management of anal fistula (AF) remains challenging with many controversies. The purpose of this study was to explore current surgical practice in the management of AF with a focus on technical variations among surgeons. METHODS:An online survey was conducted by inviting all surgeons and physicians on the membership directory of European Society of Coloproctology and American Society of Colon and Rectal Surgeons. An invitation was extended to others via social media. The survey had 74 questions exploring diagnostic and surgical techniques. RESULTS:In March 2018, 3572 physicians on membership directory were invited to take part in the study 510 of whom (14%) responded to the survey. Of these respondents, 492 (96%) were surgeons. Respondents were mostly colorectal surgeons (84%) at consultant level (84%), age ≥ 40 years (64%), practicing in academic (53%) or teaching (30%) hospitals, from the USA (36%) and Europe (34%). About 80% considered fistulotomy as the gold standard treatment for simple fistulas. Endorectal advancement flap was performed using partial- (42%) or full-thickness (44%) flaps. Up to 38% of surgeons performed ligation of the intersphincteric fistula tract (LIFT) sometimes with technical variations. Geographic and demographic differences were found in both the diagnostic and therapeutic approaches to AF. Declared rates of recurrence and fecal incontinence with these techniques were variable and did not correlate with surgeons' experience. Only 1-4% of surgeons were confident in performing the most novel sphincter-preserving techniques in patients with Crohn's disease. CONCLUSIONS:Profound technical variations exist in surgical management of AF, making it difficult to reproduce and compare treatment outcomes among different centers.

journal_name

Tech Coloproctol

journal_title

Techniques in coloproctology

authors

Ratto C,Grossi U,Litta F,Di Tanna GL,Parello A,De Simone V,Tozer P,DE Zimmerman D,Maeda Y

doi

10.1007/s10151-019-02051-5

subject

Has Abstract

pub_date

2019-08-01 00:00:00

pages

729-741

issue

8

eissn

1123-6337

issn

1128-045X

pii

10.1007/s10151-019-02051-5

journal_volume

23

pub_type

杂志文章

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