title: Sphincter-preserving fistula management: what patients want.
abstract: OBJECTIVE
  The purpose of this study was to determine how patients with anal fistulas would rank clinical scenarios describing various management options for anal fistulas.
  
  
  METHODS
  A survey was administered to 74 consecutive patients with anal fistulas. On each survey, 10 clinical scenarios describing various treatment options for anal fistulas were scored from 1 (most likely to select) to 10 (least likely to select). Mean scores for each scenario were calculated and compared by use of a Student t test.
  
  
  RESULTS
  When combined, 74% of patients selected a sphincter-preserving technique as their primary choice compared with 26% who chose a fistulotomy (P < .0001). Compared with the highest ranking sphincter-preserving techniques, the mean scores of the scenarios involving a fistulotomy were significantly (P < .05) lower (less likely to select). The mean score of a traditional fistulotomy was the same as the mean score of a sphincter-preserving technique with a 50% success rate but no risk of diminished continence.
  
  
  CONCLUSIONS
  These data suggest that the majority of patients with an anal fistula will select a sphincter-preserving technique to manage their fistula. This finding may indicate that, within limits, it is of greater importance for most patients to minimize their risk of diminished continence than to have a highly successful treatment strategy for their fistula.
authors.affiliation: Department of Surgery, West Penn Allegheny Health System, Pittsburgh, Pennsylvania 15212, USA. nellis@wpahs.org
authors.forename: C Neal
authors.initials: CN
authors.lastname: Ellis
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D003657:Decision Making; D013505:Digestive System Surgical Procedures / Q000379:methods* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012003:Rectal Fistula / Q000523:psychology / Q000601:surgery*; D011795:Surveys and Questionnaires