The outcome of fistulotomy for anal fistula at 1 year: a prospective multicentre French study

Aim The study aimed to evaluate outcome at 1 year of one- and two-stage fistulotomy for anal fistula in a large group of patients. Method 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. Conclusion 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.