Proctology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy.
Università Cattolica del Sacro Cuore, Rome, Italy.
Tech Coloproctol. 2019 Aug;23(8):729-741. doi: 10.1007/s10151-019-02051-5. Epub 2019 Jul 31.
Management of anal fistula (AF) remains challenging with many controversies. The purpose of this study was to explore current surgical practice in the management of AF with a focus on technical variations among surgeons.
An online survey was conducted by inviting all surgeons and physicians on the membership directory of European Society of Coloproctology and American Society of Colon and Rectal Surgeons. An invitation was extended to others via social media. The survey had 74 questions exploring diagnostic and surgical techniques.
In March 2018, 3572 physicians on membership directory were invited to take part in the study 510 of whom (14%) responded to the survey. Of these respondents, 492 (96%) were surgeons. Respondents were mostly colorectal surgeons (84%) at consultant level (84%), age ≥ 40 years (64%), practicing in academic (53%) or teaching (30%) hospitals, from the USA (36%) and Europe (34%). About 80% considered fistulotomy as the gold standard treatment for simple fistulas. Endorectal advancement flap was performed using partial- (42%) or full-thickness (44%) flaps. Up to 38% of surgeons performed ligation of the intersphincteric fistula tract (LIFT) sometimes with technical variations. Geographic and demographic differences were found in both the diagnostic and therapeutic approaches to AF. Declared rates of recurrence and fecal incontinence with these techniques were variable and did not correlate with surgeons' experience. Only 1-4% of surgeons were confident in performing the most novel sphincter-preserving techniques in patients with Crohn's disease.
Profound technical variations exist in surgical management of AF, making it difficult to reproduce and compare treatment outcomes among different centers.
肛门瘘管（AF）的治疗仍然具有挑战性，存在许多争议。本研究旨在探讨 AF 治疗的当前手术实践，重点关注外科医生之间的技术差异。
通过邀请欧洲结直肠外科学会和美国结直肠外科学会会员名录中的所有外科医生和医生，以及通过社交媒体向其他医生发出邀请，进行了在线调查。该调查共 74 个问题，涉及诊断和手术技术。
2018 年 3 月，向会员名录中的 3572 名医生发出了参加研究的邀请，其中 510 名（14%）医生对调查做出了回应。在这些回应者中，有 492 名（96%）是外科医生。受访者主要是 40 岁以上的结肠直肠外科医生（84%），处于顾问级别（84%），在学术（53%）或教学（30%）医院工作，来自美国（36%）和欧洲（34%）。约 80%的人认为括约肌切开术是单纯性瘘的金标准治疗方法。直肠内推进皮瓣术采用部分（42%）或全层（44%）皮瓣。多达 38%的外科医生会进行括约肌间瘘管结扎术（LIFT），有时会有技术差异。在对 AF 的诊断和治疗方法上，发现了地理和人口统计学上的差异。这些技术的复发率和粪便失禁率存在差异，且与外科医生的经验无关。只有 1-4%的外科医生对在克罗恩病患者中实施最新型的保留括约肌技术有信心。
肛门瘘管的治疗存在深刻的技术差异，使得不同中心之间难以复制和比较治疗结果。
