title: Long-term outcome of low perianal fistulas treated by fistulotomy: a multicenter study.
abstract: OBJECTIVE
  Fistulotomy is considered to be the golden standard for the treatment of low perianal fistula but might have more influence on continence status than believed. This study was performed to evaluate the healing rate after a fistulotomy and to show results for continence status.
  
  
  METHODS
  A retrospective database study was performed in one university medical center and its six affiliated hospitals. All patients treated with a fistulotomy for a low perianal fistula were identified. Healing and recurrence of the fistula were identified. Questionnaires on continence status and quality of life were mailed to all patients.
  
  
  RESULTS
  In total, 537 patients were identified. The primary etiology of the fistulas was cryptoglandular (66.5%). Recurrence was seen in 88 patients (16.4%) resulting in a primary healing rate of 83.6%. After secondary treatment for the recurrence, another 40 patients healed. This resulted in a secondary healing rate of 90.3%. The Kaplan-Meier analysis showed that at 5 years, the healing rate was 0.81 (95% confidence interval (95% CI) 0.71-0.85). The mean Vaizey score was 4.67 (SD 4.80). Major incontinence, defined as a Vaizey score of >6, was seen in 95 (28.0%) patients. Only 26.3% of the patients had a perfect continence status (Vaizey score 0). Quality of life was not different from the general population.
  
  
  CONCLUSIONS
  Fistulotomy seems to be associated with a healing rate of 0.81 (95% CI 0.71-0.85) after 5 years. However, major incontinence is still reported by 26.8% of patients and only 26.3% of patients had a perfect continence status.
authors.affiliation: Department of Surgery, Maastricht University Medical Centre, Post Box 5800, 6202 AZ, Maastricht, The Netherlands, k.gottgens@me.com.
authors.forename: K W A
authors.initials: KW
authors.lastname: Göttgens
authors.forename: P T J
authors.initials: PT
authors.lastname: Janssen
authors.forename: J
authors.initials: J
authors.lastname: Heemskerk
authors.forename: F M H
authors.initials: FM
authors.lastname: van Dielen
authors.forename: J L M
authors.initials: JL
authors.lastname: Konsten
authors.forename: T
authors.initials: T
authors.lastname: Lettinga
authors.forename: A G M
authors.initials: AG
authors.lastname: Hoofwijk
authors.forename: H J
authors.initials: HJ
authors.lastname: Belgers
authors.forename: L P S
authors.initials: LP
authors.lastname: Stassen
authors.forename: S O
authors.initials: SO
authors.lastname: Breukink
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011788:Quality of Life; D012003:Rectal Fistula / Q000473:pathology / Q000601:surgery*; D012008:Recurrence; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult