title: Outcomes after operations for anal fistula: results of a prospective, multicenter, regional study.
abstract: BACKGROUND
  There are various surgical techniques used treat anal fistulas. The adoption and success rates of newer techniques have not been clearly established.
  
  
  OBJECTIVE
  The purpose of this study was to determine the healing rate after operations for anal fistulas in New England colorectal surgery practices.
  
  
  METHODS
  We conducted a retrospective review of a prospectively collected database.
  
  
  METHODS
  The study was conducted at colorectal surgery practices in New England.
  
  
  METHODS
  A prospective, multicenter registry was created by the New England Society of Colon and Rectal Surgeons. Surgeons were invited to collect data prospectively regarding patients operated on for anal fistulas between January 1, 2011, and August 1, 2013. Fistula classification, surgical intervention, continence scores, and healing were determined by the treating surgeon.
  
  
  METHODS
  Operation for anal fistula was performed.
  
  
  METHODS
  We measured the proportion of patients with healed fistulas at 3 months.
  
  
  RESULTS
  Sixteen surgeons submitted data regarding 240 operations for fistula with curative intent. Mean patient age was 45 ± 14 years. A total of 158 patients (66%) were men, and 110 (46%) had undergone an anorectal operation. Twenty-nine (12%) had Crohn's disease. The healing rates of fistulotomy, advancement flap, and fistula plugs at 3 months were 94% (95% CI, 89-97), 60% (95% CI, 33-77), and 20% (95% CI, 5-50). The healing rate of the ligation of intersphincteric fistula tract procedure at 3 months was 79% (95% CI, 65-88). Hospital site was the only variable associated with healing (p < 0.05). Hospitals that performed more ligation of intersphincteric fistula tract procedures had higher healing rates at 3 months (p < 0.0001).
  
  
  CONCLUSIONS
  This study was limited by selection bias and reporting bias.
  
  
  CONCLUSIONS
  A wide variety of techniques are used to treat anal fistulas in our region. Fistulotomy continues to have excellent results. There has been enthusiastic early adoption of the ligation of intersphincteric fistula tract technique. Early healing rates after the ligation of intersphincteric fistula tract procedure appear to be excellent.
authors.affiliation: 1Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts 2Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts 3Department of Surgery, University of Vermont College of Medicine, Burlington, Vermont 4Department of Surgery, Hartford Healthcare Medical Group, Farmington, Connecticut.
authors.forename: Jason F
authors.initials: JF
authors.lastname: Hall
authors.forename: Liliana
authors.initials: L
authors.lastname: Bordeianou
authors.forename: Neil
authors.initials: N
authors.lastname: Hyman
authors.forename: Thomas
authors.initials: T
authors.lastname: Read
authors.forename: Christine
authors.initials: C
authors.lastname: Bartus
authors.forename: David
authors.initials: D
authors.lastname: Schoetz
authors.forename: Peter W
authors.initials: PW
authors.lastname: Marcello
mesh_terms: D000328:Adult; D005242:Fecal Incontinence / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D009511:New England; D011446:Prospective Studies; D020127:Recovery of Function; D012003:Rectal Fistula / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome; D014945:Wound Healing