Proximal anal sinus resection as an alternative to fistulectomy and seton for reducing recurrence of anal fistulas: a retrospective study

Background: The recurrence rate of anal fistula following classic surgery is a common issue. The purpose of the present study was to compare the recurrence rate of anal fistula following classic surgery (fistulectomy or seton) and proximal anal sinus resection (PASR) in a cohort study. Methods: From May 2016 to May 2018, 106 patients who did the anal fistula surgery (classic or PASR) were studied with 2 groups; 74 patients were allocated to the classic surgery group and 32 patients were allocated to the PASR group. Fifty-two patients were excluded because they did not meet the inclusion criteria. We analyzed the recurrence rate of anal fistula, wound healing time, surgical complications, and duration of pain. Results: Patient characteristics, grouped by surgical approach, showed no significant difference. There was a significant difference in the recurrence rate between the classic surgery group and the PASR group (16.2% vs. 0%, P<0.05). There was no significant difference in the surgical complications in the 2 groups (P>0.05). The mean healing time in the 2 groups was not significantly different; 41.6 days in the classic group (P>0.05) and 40.8 days in the PASR group. Our results also found no significant difference in the duration of pain between the 2 groups; 5.1 +/- 1.5 days in the classic group and 5.0 +/- 1.0 days in the PASR group (P>0.05). Conclusions: PASR was found to have a lower recurrence rate of anal fistula and did not increase the risk of complications. Therefore, PASR should be considered as a first line of treatment for patients at risk of anal fistula recurrence.