Recurrence Pattern of Fistula-in-Ano in a Chinese
Full Article (PDF file)
Poon Chi-Ming, Ng Dennis Chung-Kei, Cheung Michael Ho-Yin,
Li Raymond Shiu-Ki, Leong Heng-Tat
Department of Surgery, North District Hospital, Hong Kong SAR,
Background and aims: Fistula-in-ano is a common
colorectal complaint. Despite of the advancement in preoperative
imaging and surgical techniques, recurrence is not uncommon in
this disease entity. We aimed to determine the recurrence pattern
and predictors of FIA in Chinese population.
Methods: Setting: single regional hospital serving
a 300,000 population. Design and Participants: A systematic retrospective
review of inpatient and follow up records and operation records
in patients with diagnosis of fistula-in-ano (ICD code - 565.1)
from January 2001 to December 2004 was performed. Intervention:
Surgery for fistula-in-ano.
Results: 135 out of 137 Chinese patients received
anal fistula operations. 14 patients (10.4%) had high type anal
fistulas and 27 patients (20%) had perianal sinus. The most common
operation was combined fistulotomy-fistulectomy (78 patients,
57.8%). 18 patients (13.3%) had recurrence with a median time
to recurrence of 7.5 months. Six factors including: 1) positive
history of perianal abscess, 2) previous perianal operation, 3)
complex fistula, 4) perianal sinus, 5) absence of an internal
opening, 6) surgical procedure of sinus tract excision were significantly
associated with recurrence in univariate analysis. Sinus tract
excision was the only independent factor to predict recurrence
in logistic regression (p=0.002, 95%CI=1.29-3.27).
Conclusion: Fistula-in-ano carried a significant
risk of recurrence in perianal sinus with sinus tract excision
performed. No difference was found between Chinese and Caucasian
in recurrence pattern of fistula-in-ano.
Fistula-in-ano - recurrence - endoanal ultrasound