Ratto Carlo, Marra Angelo Alessandro, Parello Angelo, De Simone Veronica, Campennì Paola, Litta Francesco
Proctology Unit, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, 00168 Rome, Italy.
Department of Medicine and Translational Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
J Clin Med. 2023 Jan 20;12(3):825. doi: 10.3390/jcm12030825.
Traditional fistulotomy is the most performed surgical procedure in anal fistula surgery. We conducted an international online survey to explore colorectal surgeons' opinions and preferences on fistulotomy. Considering the healing and continence impairment rates reported in the literature, surgeons were invited to answer as a hypothetic patient susceptible to being submitted to fistulotomy for low and high anal fistula. A total of 767 surgeons completed the survey from 72 countries. The majority of respondents were consultants, having treated more than 20 anal fistulas in the last year. Most of them declared that anal fistula would be able to negatively affect quality of life and would be worried/anxious about it. Taking into account all aspects, 87.5% and 37.8% of respondents would agree to be treated with a fistulotomy in case of a low and high fistula, respectively, with an acceptance rate that varied worldwide. At multivariate analysis, factors correlated to the acceptance of anal fistulotomy were male gender ( = 0.003), practice of less than 20 fistula operations during last year ( = 0.020), and low fistula ( < 0.001). Surgeons recognized the extreme complexity of this approach. This study highlighted the necessity of an accurate patients' selection and the adoption of alternative strategy to reduce the risk of anal continence impairment.
传统肛瘘切开术是肛瘘手术中最常施行的外科手术。我们开展了一项国际在线调查，以探究结直肠外科医生对肛瘘切开术的看法和偏好。鉴于文献中报道的愈合率和控便功能受损率，邀请外科医生以可能接受低位和高位肛瘘切开术的假想患者身份进行作答。共有来自72个国家的767名外科医生完成了该调查。大多数受访者为顾问医生，去年治疗过20例以上的肛瘘。他们中的大多数人表示肛瘘会对生活质量产生负面影响，并对此感到担忧/焦虑。综合各方面因素，87.5%和37.8%的受访者分别表示若患有低位和高位肛瘘会同意接受肛瘘切开术治疗，接受率在全球范围内有所不同。在多变量分析中，与接受肛瘘切开术相关的因素为男性（ = 0.003）、去年肛瘘手术操作少于20例（ = 0.020）以及低位肛瘘（ < 0.001）。外科医生认识到这种手术方式极其复杂。这项研究强调了准确选择患者以及采用替代策略以降低肛门控便功能受损风险的必要性。
