Operative Management of Fistula-in-Ano: A Four Year Retrospective Outcome Analysis

Abstract

Objective: To evaluate fistula types, surgical strategies, healing, recurrence and continence. This evaluation was conducted in a non-tertiary setting.

Study Design: A retrospective analysis.
Place and Duration of Study: This study was conducted at the surgical department, Shaqra General Hospital, Shaqra, Kingdom of Saudi Arabia between November 2021 and October 2025.

Methods: This study was analysed the 56 consecutive adult patients (48 males, 8 females). The median age of patients was 44 years who underwent surgery for anal fistula. Fistulas were classified using Parks criteria with preoperative endoanal ultrasound, MRI and examination under anaesthesia. Simple fistulas were treated by fistulotomy/fistulectomy, and complex fistulas were managed with LIFT, cutting or loose Seton (Crohn’s disease).

Results: The cryptoglandular fistulas comprised 94.6% of patients and crohn’s-related patients were 5.4% of the total study sample. Low intersphincteric fistulas were found to be most commonly occurring (55.4%), followed by high transsphincteric fistula (30.4%). Out of the total study sample, simple fistulas accounted for 66.1% and complex were 33.9%. In 47 patients primary healing was achieved (83.9%) at a median follow up time of 22 months (92.9% traceability). Recurrence was found in five patients (8.9%), all these cases of recurrence happened within 6 months. No major complications were recorded during the study.

Conclusion: High healing rates (83.9%) were found in patients treated with conventional techniques tailored to each fistula anatomy in the general colorectal unit with a low recurrence rate (8.9%). The outcomes of this study support the efficacy of established procedures in routine practice.