title: The outcome of fistulotomy for anal fistula at 1 year: a prospective multicentre French study.
abstract: OBJECTIVE
  The study aimed to evaluate outcome at 1 year of one- and two-stage fistulotomy for anal fistula in a large group of patients.
  
  
  METHODS
  A prospective multicentre observational study was designed to include patients with anal fistula treated by one- or two-stage fistulotomy. Data were collected using a self-administered questionnaire before surgery, during healing and at 1 year after surgery.
  
  
  RESULTS
  Group A (133 patients) with a low anal fistula underwent a one-stage fistulotomy. The median Wexner scores before and after surgery were 1.0 (0-11) and 2.0 (0-18) (P = 0.032) and the median Vaizey scores were 2.0 (0-14) and 3.0 (0-21) (P = 0.055). The Wexner scores and percentage of patients before and after fistulotomy were as follows: 0-5: 88%, 86%; 6-10: 10.7%, 10.7%; 11-15: 1.0%, 2.6%; and 16-20: 0%, 2%. Eighty-seven per cent of the patients were satisfied. Group B (62 patients) underwent two-stage fistulotomy for a high transsphincteric fistula. The Wexner scores and percentage of patients before the first stage and 1 year after the second stage were as follows: 0-5: 86%, 66%; 6-10: 4.5%, 20%; 11-15: 9%, 11%; and 16-20: 0%, 2%. The median Wexner scores before the first stage and after the second stage were 1 (0-14) vs. 4 (0-19) (P < 0.001), and the median Vaizey scores were 1.5 (0-11) vs. 4 (0-20) (P < 0.001). Eighty-eight per cent of the patients were satisfied.
  
  
  CONCLUSIONS
  Low transsphincteric anal fistula can be treated by fistulotomy without clinically significant continence disturbance. Treating high transsphincteric anal fistulae with two-stage fistulotomy is followed by mild continence disturbance. Satisfaction rates were high.
authors.affiliation: Proctologie Médico-Chirurgicale, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Abramowitz
authors.affiliation: Institut de Proctologie Léopold Bellan, Hôpital Saint Joseph, Paris, France.
authors.forename: D
authors.initials: D
authors.lastname: Soudan
authors.affiliation: Service de Proctologie, Clinique Saint Augustin, Nantes, France.
authors.forename: M
authors.initials: M
authors.lastname: Souffran
authors.affiliation: Service de Proctologie, Hôpital Bagatelle, Talence, France.
authors.forename: D
authors.initials: D
authors.lastname: Bouchard
authors.affiliation: Clinique Théodore Ducos, Bordeaux, France.
authors.forename: A
authors.initials: A
authors.lastname: Castinel
authors.affiliation: Service de Proctologie, Clinique St Jean Languedoc, Toulouse, France.
authors.forename: J M
authors.initials: JM
authors.lastname: Suduca
authors.affiliation: Service de Proctologie, Clinique St Jean Languedoc, Toulouse, France.
authors.forename: G
authors.initials: G
authors.lastname: Staumont
authors.affiliation: Clinique Courlancy, Reims, France.
authors.forename: F
authors.initials: F
authors.lastname: Devulder
authors.affiliation: Service de Proctologie, Hôpital Bagatelle, Talence, France.
authors.forename: F
authors.initials: F
authors.lastname: Pigot
authors.affiliation: Institut de Proctologie Léopold Bellan, Hôpital Saint Joseph, Paris, France.
authors.forename: R
authors.initials: R
authors.lastname: Ganansia
authors.affiliation: ClinSearch, Bagneux, France.
authors.forename: M
authors.initials: M
authors.lastname: Varastet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000523:psychology; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology; D011184:Postoperative Period; D011446:Prospective Studies; D012003:Rectal Fistula / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Anal fistula; anal incontinence; fistulotomy; seton