title: Risk factors for recurrence and incontinence after anal fistula surgery.
abstract: OBJECTIVE
  Fistula-in-ano continues to raise problems that require important therapeutic decisions. Our aim was to evaluate its recurrence and incontinence risk factors.
  
  
  METHODS
  We analysed a series of 279 patients who had undergone anal fistula surgery with long-term follow-up.
  
  
  RESULTS
  42.7% of the fistulae were considered complex and 46% had been referred from other institutions. There was delayed healing or recurrence in 7.2% patients, which appeared at a median of 4 months. The factors associated with recurrence were the type of fistula (extrasphincteric/suprasphincteric), nonidentification of internal opening (IO), recurrent or complex fistulae (CF), and associated chronic abscess. Only CF and nonidentification of IO were statistically significant in the multivariate analysis. Preoperative incontinence was a risk factor for postoperative incontinence, as were suprasphincteric, recurrent and CF. The age and gender of the patient did not influence postoperative continence, nor did the surgeon or surgical technique appear as a risk factor, although after excluding preoperative incontinent patients, fistulotomy was the technique that showed a higher risk of incontinence. Multivariate analysis only confirmed previous incontinence as a RF.
  
  
  CONCLUSIONS
  The overall recurrence rate is acceptable, but high fistulae continue to be difficult to treat. IO identification is also essential for obtaining good results. It is important to identify the patients with preoperative incontinence as they are at a greater risk of deterioration after surgery.
authors.affiliation: Department of General and Digestive Surgery, Hospital Universitario de Tenerife, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Jordán
authors.forename: J V
authors.initials: JV
authors.lastname: Roig
authors.forename: J
authors.initials: J
authors.lastname: García-Armengol
authors.forename: E
authors.initials: E
authors.lastname: García-Granero
authors.forename: A
authors.initials: A
authors.lastname: Solana
authors.forename: S
authors.initials: S
authors.lastname: Lledó
mesh_terms: D000328:Adult; D013505:Digestive System Surgical Procedures; D005242:Fecal Incontinence / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012003:Rectal Fistula / Q000150:complications* / Q000601:surgery*; D012008:Recurrence