title: Patient satisfaction after surgical treatment for fistula-in-ano.
abstract: OBJECTIVE
  The surgical treatment of fistula-in-ano frequently results in recurrence of the fistula or postoperative anal incontinence. Despite these problems, most patients are satisfied with the results of their surgery. To clarify this apparent discrepancy, we attempted to identify factors that affect patient's lifestyles and may contribute to their satisfaction.
  
  
  METHODS
  A questionnaire was mailed to 624 patients surgically treated for cryptoglandular fistula-in-ano at the University of Minnesota during a five-year period. Three hundred seventy-five patients returned their questionnaires. Patients 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 logistic regression. Attributable fractions for patient dissatisfaction were calculated using study population dissatisfaction rates.
  
  
  RESULTS
  Patient satisfaction was strongly associated with fistula recurrence, difficulty holding 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 affected by incontinence. Patients with fistula recurrence reported a higher dissatisfaction 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). Patient satisfaction was not significantly associated with age, gender, history of previous fistula surgery, type of fistula, surgical procedure, time since surgery, or operating surgeon.
  
  
  CONCLUSIONS
  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 mainly with laying open of the fistula tract, patients with fistula recurrence had a higher dissatisfaction rate than did patients with anal incontinence. However, because anal incontinence was more prevalent than fistula recurrence, a higher fraction of dissatisfaction was attributable to anal incontinence.
authors.affiliation: Division of Colon and Rectal Surgery, University of Minnesota, Minneapolis, USA.
authors.forename: J
authors.initials: J
authors.lastname: García-Aguilar
authors.forename: C S
authors.initials: CS
authors.lastname: Davey
authors.forename: C T
authors.initials: CT
authors.lastname: Le
authors.forename: A C
authors.initials: AC
authors.lastname: Lowry
authors.forename: D A
authors.initials: DA
authors.lastname: Rothenberger
mesh_terms: D000367:Age Factors; D000368:Aged; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011788:Quality of Life; D012003:Rectal Fistula / Q000601:surgery*; D012008:Recurrence; D012737:Sex Factors; D011795:Surveys and Questionnaires