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Assessment of risk factors for recurrence of complex anal fistulas
https://doi.org/10.17021/1992-6499-2025-3-53-63
Abstract
A retrospective study was conducted on the treatment of 151 (100 %) patients with transsphincteric and extrasphincteric anal fistulas operated on in 2020-23. In the main group (n=70), two-stage treatment was performed: ligature-frame (patent for invention No. 2835127), followed by sphincteroplasty (36.4 %) or plastic surgery with a displaced flap (9.9 %). In the control group (n = 81), a single-stage treatment was performed: sphincteroplasty (41.7 %) or plastic surgery with a mixed flap (11.9 %). The groups were comparable by sex (p = 0.736), age (p = 0.703), disease duration (p = 0.394), comorbidity (p = 0.075), and body mass index (p = 0.851). The distribution of the internal fistula openings (anterior, posterior, and lateral) did not differ (p = 0.517–0.799). The average surgery time in the main group was 28 minutes, in the control group – 30 minutes (p = 0.082). A binary logistic regression study (n = 151) showed that the anterior localization of the internal fistula opening is the only significant predictor of disease recurrence (p = 0.045). Gender, age, body mass index, and other factors studied showed no significant association with disease recurrence (p > 0.05). It was also found that the method of surgical treatment significantly affects the outcome of treatment: single-stage surgery (sphincteroplasty) increases the risk of disease recurrence by 4.95 times (p = 0.016); plastic surgery with a divided flap – by 17.33 times (p < 0.001). Binary logistic regression analysis demonstrated moderate predictive ability (pseudo-R2 = 17.8 %), with a sensitivity of 89.7 % and a specificity of 42.6 %. It has been established that the anatomy of the fistula and the choice of the surgical method are critical for the prognosis of disease recurrence.
About the Authors
A. Ya. Ilkanich
Surgut State University;
Surgut District Clinical Hospital
Россия
Россия
Andrei Ya. Ilkanich, Dr. Sci. (Med.), Professor of the Department, Surgut State University; Head of the Department of Coloproctology, Surgut District Clinical Hospital
Surgut
K. Z. Zubailov
Surgut State University;
Surgut District Clinical Hospital
Россия
Россия
Kazimagomed Z. Zubailov, postgraduate student, Surgut State University; Coloproctologist, Head of the Department, Surgut District Clinical Hospital
Surgut
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Review
For citations:
Ilkanich A.Ya., Zubailov K.Z. Assessment of risk factors for recurrence of complex anal fistulas. Astrakhan medical journal. 2025;20(3):53-63. (In Russ.) https://doi.org/10.17021/1992-6499-2025-3-53-63
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