Evaluation of reasons of recurrence of anal fistula

The most important complications of anal fistula are gas, fecal incontinence and fistula recurrence. Recurrence can lead to frequent hospitalization, multiple surgeries, more tissue damage, more time and high cost. Considering the fact that most causes of fistula recurrence can be preventable, we studied factors that were effective on recurrence.

In this cross-sectional (descriptive-analytical) study, 50 patients with recurrence of anal fistula that had referred to Rasoul Akram Hospital between April to September 2006 were enrolled. A questionnaire including age, sex, duration of disease, history of fistula surgery, history of abscess surgery, history of spontaneous abscess drainage, underlying diabetes mellitus, corticosteroid use, number of recurrence, the number and location of internal and external orifices were completed. The second part of the questionnaire was completed after the operation when the complete anatomy of the fistula and the previous surgical errors were determined. SPSS version 24 was used for statistical analysis.

50 patients with mean age of 42.5±12.3 years were studied and on average 3.33±4.0 years had anal fistula. In this study, 8 types of fistula recurrence were studied; 18(36%) patients  due to extensive superalevator collection, 7(14%) patients due to lack of internal orifices, 3 (6%) patients due to Inflammatory Bowel Disease (IBD), 6 (12%) due to inadequate follow-up, 6(12%) due to horseshoe fistula, 7(14%) due to rectovaginal fistula, 1 person (2%) due to retro rectal mass and 2(4%) patients due to unknown curve extension. There was also a significant relationship between the cause of recurrence and the type of primary tract of fistula (p= 0.035).

Using appropriate technique of anal fistula surgery based on patientchr('39')s condition and considering the main fistula tract, can reduce the rate of fistula recurrence and postoperative complications.