Fistula-IN-ANO : a prospective audit

الملخص EN

Objective : Fistula-in-ano is a common condition that is characterized by intermittent pain and discharge.

We present an audit of all patients seen with anal fistula at Prince Hashem Hospital during an eighteen month period.

Methods : This audit includes all patients that underwent examination under anesthetic for fistula-in-ano from September 2006 to May 2008.

Anatomic classification and operative procedures of all fistulae were recorded.

Patients were followed-up for a mean period of 13 months and details of wound healing, fistula recurrence and function were gathered.

Results : Forty three consecutive patients underwent examination under anesthesia for fistula.

There were 36 males with a mean age of 32.2 years (range 17-65).

Eight (18.6%) patients had superficial, 15 (34.9%) intersphincteric, 17 (39.5%) transphincteric, 3 (7%) suprasphincteric and none had extrasphincteric fistulae.

Forty (93%) patients had fistulae of cryptoglandular (idiopathic) origin.

Two (4.7%) patients had Crohn’s disease and one (2.3%) had low rectal malignancy.

Thirty two (74.4%) patients underwent fistulotomy.

One (2.3%) patient had advancement flap.

Nine (21%) patients had loose seton in situ and one patient underwent abdominoperineal resection.

Four (9.5%) patients had some degree of flatus incontinence, two (4.8%) had incontinence to liquid stool.

Soiling was present in one patient.

Conclusions : Fistula-in-ano is relatively a common condition in Jordan.

Its variation in anatomical distribution should alert the surgeons for the variety of surgical options available for its treatment, especially the difficult and complex ones, that should be managed by a colorectal surgeon or general surgeon that has adequate experience in this field.

Unusual causes like Crohn’s disease and malignancy should be kept in mind in complex, unhealed fistulae.