FISSIT (Fistula Surgery in Italy) study: A retrospective survey on the surgical management of anal fistulas in Italy over the last 15 years.
Journal
Surgery
ISSN: 1532-7361
Titre abrégé: Surgery
Pays: United States
ID NLM: 0417347
Informations de publication
Date de publication:
09 2021
09 2021
Historique:
received:
28
10
2020
revised:
21
02
2021
accepted:
23
02
2021
pubmed:
14
4
2021
medline:
26
11
2021
entrez:
13
4
2021
Statut:
ppublish
Résumé
Surgical treatment of anal fistulas is still a challenge. The aims of this study were to evaluate the adoption and healing rates for the different surgical techniques used in Italy over the past 15 years. This was a multicenter retrospective observational study of patients affected by simple and complex anal fistulas of cryptoglandular origin who were surgically treated in the period 2003-2017. Surgical techniques were grouped as sphincter-cutting or sphincter-sparing and as technology-assisted or techno-free. All patients included in the study were followed for at least 12 months. A total of 9,536 patients (5,520 simple; 4,016 complex fistulas) entered the study. For simple fistulas, fistulotomy was the most frequently used procedure, although its adoption significantly decreased over the years (P < .0005), with an increase in sphincter-sparing approaches; the overall healing rate in simple fistulas was 81.1%, with a significant difference between sphincter-cutting (91.9%) and sphincter-sparing (65.1%) techniques (P = .001). For complex fistulas, the adoption of sphincter-cutting approaches decreased, while sphincter-sparing techniques were mildly preferred (P < .0005). Moreover, there was a significant trend toward the use of technology-assisted procedures. The overall healing rate for complex fistulas was 69.0%, with a measurable difference between sphincter-cutting (81.1%) and sphincter-sparing (61.4%; P = .001) techniques and between techno-free and technology-assisted techniques (72.5% and 55.0%, respectively; P = .001). Surgical treatment of anal fistulas has changed, with a trend toward the use of sphincter-sparing techniques. The overall cure rate has remained stable, even if the most innovative procedures have achieved a lower success rate.
Sections du résumé
BACKGROUND
Surgical treatment of anal fistulas is still a challenge. The aims of this study were to evaluate the adoption and healing rates for the different surgical techniques used in Italy over the past 15 years.
METHODS
This was a multicenter retrospective observational study of patients affected by simple and complex anal fistulas of cryptoglandular origin who were surgically treated in the period 2003-2017. Surgical techniques were grouped as sphincter-cutting or sphincter-sparing and as technology-assisted or techno-free. All patients included in the study were followed for at least 12 months.
RESULTS
A total of 9,536 patients (5,520 simple; 4,016 complex fistulas) entered the study. For simple fistulas, fistulotomy was the most frequently used procedure, although its adoption significantly decreased over the years (P < .0005), with an increase in sphincter-sparing approaches; the overall healing rate in simple fistulas was 81.1%, with a significant difference between sphincter-cutting (91.9%) and sphincter-sparing (65.1%) techniques (P = .001). For complex fistulas, the adoption of sphincter-cutting approaches decreased, while sphincter-sparing techniques were mildly preferred (P < .0005). Moreover, there was a significant trend toward the use of technology-assisted procedures. The overall healing rate for complex fistulas was 69.0%, with a measurable difference between sphincter-cutting (81.1%) and sphincter-sparing (61.4%; P = .001) techniques and between techno-free and technology-assisted techniques (72.5% and 55.0%, respectively; P = .001).
CONCLUSION
Surgical treatment of anal fistulas has changed, with a trend toward the use of sphincter-sparing techniques. The overall cure rate has remained stable, even if the most innovative procedures have achieved a lower success rate.
Identifiants
pubmed: 33846008
pii: S0039-6060(21)00179-3
doi: 10.1016/j.surg.2021.02.055
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
689-695Investigateurs
Angelo Parello
(A)
Veronica De Simone
(V)
Luigi Bracchitta
(L)
Alessandro Sturiale
(A)
Giacomo Lo Secco
(G)
Sara Salomone
(S)
Luigi Velci
(L)
Arcangelo Picciariello
(A)
Vincenzo Papagni
(V)
Filippo Caponnetto
(F)
Cristina Folliero
(C)
Tiziana Cozza
(T)
Fulvio Leopardi
(F)
Michela Campanelli
(M)
Andrea Divizia
(A)
Gianfranco Cocorullo
(G)
Elio D'Agostino
(E)
Massimiliano Boccuzzi
(M)
Francesco Pezzolla
(F)
Gianluca Pagano
(G)
Stefano Mancini
(S)
Monica Ortenzi
(M)
Sergio Calandra
(S)
Edoardo Scarpa
(E)
Enrico Magni
(E)
Fabio Cesare Campanile
(FC)
Lucia Romano
(L)
Francesco Maffione
(F)
Simone Maria Tierno
(SM)
Roberto Peltrini
(R)
Informations de copyright
Copyright © 2021 Elsevier Inc. All rights reserved.