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Session: ePoster: Benign Anorectal 1 (Sun8)

EP232 - ASCRS Member Survey of Anal Fistulas and Fissures

Sunday, May 11, 2025
8:16 AM – 8:21 AM PT
Location: Monitor 3, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • JM

    Jeffrey Milsom, MD, FACS,FASCRS

    Professor of Surgery
    Weill Cornell Medicine
    New York City, NY, United States

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

    • Senior Author(s)

  • PF

    Paul Finnegan, MD, FRCPC

    Chief Medical Officer, Safety Officer
    Angiocrine Bioscience
    San Diego, California, United States

    Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.
Jeffrey Milsom, MD, FACS,FASCRS: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: There is paucity of quantitative data in the literature regarding spontaneous healing rates (SHR) of anal fistulas and fissures, specifically cryptoglandular transsphincteric peri-anal fistulas (PAF) and medical refractory chronic anal fissures (CAF). Qualitatively, both conditions are universally described as having low SHRs—i.e., rarely healing on its own.

Methods/Interventions: An 18-question survey, timed to be < 3 minutes, was approved by the American Society of Colon and Rectal Surgeons (ASCRS) Executive Council. ASCRS blast emails with a link to the survey were sent to 3,121 members of which approximately 45% (~1,400) are ABCRS certified colorectal surgeons. Surveys were sent in August 2024 and closed end of September 2024. The survey was voluntary and anonymous, and accessible via smartphone or laptop; responses were recorded and analyzed via a secure online survey platform.

Results/Outcomes: 223 ASCRS member surgeons with active practice treating anal fistulas and fissures responded (~16% response rate among surgeon members). SHRs of peri-anal fistulas were estimated to be the following: cryptoglandular transsphincteric simple PAF 5% (median, 0-10% IQR); cryptoglandular transsphincteric complex PAF 0% (median, 0-1% IQR); and Crohn’s PAF 10% (median 0-30% IQR). 85% of respondents noted SHRs of simple transsphincteric PAF to be ≤ 10%; 96% of respondents noted complex PAF to be ≤ 10%. Spontaneous healing rates of medical refractory CAFs were estimated to be the following: vasodilator failure 10% (median, 0-25% IQR); and, vasodilator and botulinum toxin failure 5% (median 0-15% IQR). 56% of respondents noted SHR of vasodilator refractory CAF to be ≤ 10%; while, 73% of respondents noted SHR of vasodilator-and-botulinum-toxin refractor CAF to be ≤ 10%.

Conclusion/Discussion: This is the first ASCRS survey that aims to better quantify the general impression in the colorectal surgery field and literature that SHRs of trans-sphincteric PAFs and medical refractory CAFs are low. The rates of both conditions are indeed low and likely to be ≤ 10%. This data will be supportive in designing and sizing future trials involving PAF and CAF.