EP114 - Surgical Outcomes in Anal Fistula Management: A Retrospective Cohort Study Based on Parks Classification

ePoster Presenter(s)

• 

  CHUANG WU, 22GDDAEA1403 (he/him/his)

  Deputy Director of Surgery
  Shanghai Baoshan District Hospital of Integrated Traditional Chinese and Western Medicine
  Shanghai, Shanghai, China (People's Republic)

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

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Author(s)

• hz

  haiyan zhang, n/a

  Anorectal Medicine Department
  Shanghai Baoshan District Hospital of Integrated Traditional Chinese and Western Medicine
  Shanghai, Shanghai, China (People's Republic)

  Disclosure information not submitted.
• th

  ting huang, n/a

  Anorectal Medicine Department
  Shanghai Baoshan District Hospital of Integrated Traditional Chinese and Western Medicine
  Shanghai, Shanghai, China (People's Republic)

  Disclosure information not submitted.
• wm

  wenjing mao, n/a

  Anorectal Medicine Department
  Shanghai Baoshan District Hospital of Integrated Traditional Chinese and Western Medicine
  shanghai, Shanghai, China (People's Republic)

  Disclosure information not submitted.
• jx

  jin xu, n/a

  Anorectal Medicine Department
  Shanghai Baoshan District Hospital of Integrated Traditional Chinese and Western Medicine
  Shanghai, Shanghai, China (People's Republic)

  Disclosure information not submitted.
• wz

  wenjun zhao, n/a

  Anorectal Medicine Department
  Shanghai Baoshan District Hospital of Integrated Traditional Chinese and Western Medicine
  Shanghai, Shanghai, China (People's Republic)

  Disclosure information not submitted.
• zz

  zhiming zhu, n/a

  Anorectal Medicine Department
  Shanghai Baoshan District Hospital of Integrated Traditional Chinese and Western Medicine
  Shanghai, Shanghai, China (People's Republic)

  Disclosure information not submitted.
• YL

  Yicheng Liu, Resident

  Resident
  Baoshan Hospital of Integrated Traditional Chinese and Western Medicine
  Shanghai, Shanghai, China (People's Republic)

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• ct

  cheng tang, n/a

  Anorectal Medicine Department
  Shanghai Baoshan District Hospital of Integrated Traditional Chinese and Western Medicine
  Shanghai, Shanghai, China (People's Republic)

  Disclosure information not submitted.

Senior Author(s)

• QW

  Qingming Wang, Doctor

  professor
  Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine
  ShangHai, Shanghai, China (People's Republic)

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Purpose/Background: This study aimed to evaluate the surgical outcomes of anal fistulas classified according to the Parks classification, with a focus on identifying safe and effective treatments for different fistula types.

Methods/Interventions: A retrospective analysis was conducted on 483 patients with anal fistulas at our institution, categorized by the Parks classification. Surgical interventions included fistulotomy, transanal opening of the intersphincteric space (TROPIS), the bared external anal sphincter (BEAS), seton placement, and fistulotomy with drainage. Primary outcomes, including healing rate, recurrence rate, postoperative pain, wound healing time, and fecal incontinence, were compared across fistula types. Binary logistic regression and multivariate logistic regression models were used to analyze factors associated with fistula complexity and the need for reoperation.

Results/Outcomes: The median follow-up time was 1,289 days. Inter-sphincteric fistulas (IAF) comprised 29.4%, trans-sphincteric fistulas (TAF) 55.49%, supra-sphincteric fistulas (SAF) 13.25%, and extra-sphincteric fistulas (EAF) 1.86%. Fistulotomy was primarily used for IAF, while 40.3% of TAF cases underwent fistulotomy and 32.84% had seton placement. BEAS was employed in 57.81% of SAF cases, and 33.33% and 55.55% of EAF cases were treated with TROPIS and BEAS, respectively. The overall healing rate was 85.51%, with a recurrence rate of 14.91%. The median healing time was 52 days, significantly shorter for IAF than SAF (41 days vs 74 days, P< 0.001). Fecal incontinence occurred in 8.9% of patients, and the reoperation rate was 14.91%, with SAF having a significantly higher reoperation rate (50%) compared to IAF (2.82%) and TAF (13.06%) (P < 0.001). Smoking (OR=2.275, P< 0.005), internal opening height (OR=1.085, P< 0.005), and fistula length (OR=1.249, P< 0.001) were significantly associated with fistula complexity. Risk factors for reoperation included smoking, obesity, alcohol consumption, internal opening height, and pain on postoperative day 7 (P < 0.01), while wound healing time (OR=0.96, P< 0.05) was a protective factor.

Conclusion/Discussion: Fistulotomy is safe and effective for intersphincteric fistulas. For more complex fistulas (TAF, SAF, EAF), newer techniques such as BEAS and TROPIS show promising results. Internal opening height and fistula length are key determinants of fistula complexity and surgical choice. Smoking, alcohol consumption, and obesity are potential risk factors for surgical failure. Large-scale prospective studies are needed to refine treatment strategies and reduce recurrence rates in complex anal fistulas.

Table 1. Baseline Demographic, Clinical Characteristics, Perioperative Data and Postoperative Complications of Patients with Anal Fistula by Parks Classification
Notes:*P <0.05 compared to IAF. △P <0.05 compared to TAF. IAF: Intersphincteric anal fistula; TAF: Transsphincteric anal fistula; SAF: Suprasphincteric anal fistula; EAF: Extrasphincteric anal fistula; IO: Internal opening; EO: External opening; VAS: Visual Analogue Scale; TROPIS: Transanal opening of the intersphincteric space; BEAS: Bared external anal sphincter; CCF-FI: Cleveland Clinic Florida Fecal Incontinence Score.

Table 2. Risk Factors Associated with Anal Fistula Complexity: Multivariate Analysis
OR: Odds Ratio; CI: Confidence Interval; IO: Internal Opening; VAS: Visual Analogue Scale.