Risk Factors for Recurrence and Morbidity After Surgery for High Trans-sphincteric Anal Fistula
Keywords:
High transsphincteric fistula, recurrence, postoperative complications, wound infectionAbstract
Introduction: High trans-sphincteric fistula-in-ano presents significant management challenges owing to its complex anatomy and high risk of recurrence. Despite advancements in surgical techniques, postoperative complications and recurrences remain major concerns. Identifying the factors that influence these outcomes is crucial for optimizing the treatment strategies. This study aimed to evaluate factors affecting postoperative complications and recurrence in patients undergoing surgery for high transsphincteric fistula-in-ano.
Methods: This prospective observational study was conducted at the Department of Colorectal Surgery, Bangladesh Medical University (BMU), Dhaka, Bangladesh, from June 2021 to May 2022. Total 36 patients who underwent surgical management for high transsphincteric fistula-in-ano were included in this study. Patient demographics, fistula characteristics, surgical outcomes, and postoperative complications were also analyzed.
Results: The recurrence rate was 19.4%, and wound infection was significantly associated with recurrence(P=0.033). No significant association was found between fistula location and recurrence (p>0.05). Postoperative continence outcomes were favorable, with 91.2% of the patients maintaining Grade A continence. Suture line dehiscence was observed in11.1%of cases. These findings emphasize the critical role of infection control in preventing recurrence.
Conclusion: Wound infection was a significant predictor of recurrence in patients with high transsphincteric fistula-in-ano, underscoring the need for stringent perioperative infection control. This study supports the effectiveness of sphincter-preserving techniques for maintaining continence. Further research with larger cohort sand longer follow-up periods is needed to optimize treatment strategies and improve patient outcomes.
Journal of Surgical Sciences 2025;29(1): 14-18
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