PMID- 31368010
OWN - NLM
STAT- MEDLINE
DCOM- 20200504
LR  - 20200505
IS  - 1128-045X (Electronic)
IS  - 1123-6337 (Print)
IS  - 1123-6337 (Linking)
VI  - 23
IP  - 8
DP  - 2019 Aug
TI  - Contemporary surgical practice in the management of anal fistula: results from an 
      international survey.
PG  - 729-741
LID - 10.1007/s10151-019-02051-5 [doi]
AB  - BACKGROUND: 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. 
      METHODS: 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. RESULTS: 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. CONCLUSIONS: 
      Profound technical variations exist in surgical management of AF, making it 
      difficult to reproduce and compare treatment outcomes among different centers.
FAU - Ratto, C
AU  - Ratto C
AD  - Proctology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. 
      Gemelli, 8, 00168, Rome, Italy.
AD  - Universita Cattolica del Sacro Cuore, Rome, Italy.
FAU - Grossi, U
AU  - Grossi U
AD  - Proctology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. 
      Gemelli, 8, 00168, Rome, Italy. ugo.grossi@qmul.ac.uk.
AD  - National Bowel Research Centre, Queen Mary University of London, London, UK. 
      ugo.grossi@qmul.ac.uk.
FAU - Litta, F
AU  - Litta F
AD  - Proctology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. 
      Gemelli, 8, 00168, Rome, Italy.
FAU - Di Tanna, G L
AU  - Di Tanna GL
AD  - Statistics Division, The George Institute for Global Health, UNSW, Sydney, 
      Australia.
FAU - Parello, A
AU  - Parello A
AD  - Proctology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. 
      Gemelli, 8, 00168, Rome, Italy.
FAU - De Simone, V
AU  - De Simone V
AD  - Proctology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. 
      Gemelli, 8, 00168, Rome, Italy.
FAU - Tozer, P
AU  - Tozer P
AD  - Fistula Research Unit, St Mark's Hospital and Academic Institute, London, UK.
AD  - Imperial College London, London, UK.
FAU - DE Zimmerman, D
AU  - DE Zimmerman D
AD  - Department of Surgery, ETZ (Elisabeth-TweeSteden Hospital), Tilburg, The 
      Netherlands.
FAU - Maeda, Y
AU  - Maeda Y
AD  - Department of Colorectal Surgery, Western General Hospital, Edinburgh, UK.
LA  - eng
PT  - Journal Article
DEP - 20190731
PL  - Italy
TA  - Tech Coloproctol
JT  - Techniques in coloproctology
JID - 9613614
SB  - IM
MH  - Adult
MH  - Anal Canal/*surgery
MH  - Colorectal Surgery/*statistics & numerical data
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Practice Patterns, Physicians'/*statistics & numerical data
MH  - Rectal Fistula/*surgery
MH  - Surveys and Questionnaires
PMC - PMC6736896
OTO - NOTNLM
OT  - Anal fistula
OT  - Incontinence
OT  - LIFT
OT  - Recurrence
OT  - Survey
OT  - VAAFT
COIS- The authors declare that they have no conflict of interest.
EDAT- 2019/08/02 06:00
MHDA- 2020/05/06 06:00
PMCR- 2019/07/31
CRDT- 2019/08/02 06:00
PHST- 2019/05/14 00:00 [received]
PHST- 2019/07/19 00:00 [accepted]
PHST- 2019/08/02 06:00 [pubmed]
PHST- 2020/05/06 06:00 [medline]
PHST- 2019/08/02 06:00 [entrez]
PHST- 2019/07/31 00:00 [pmc-release]
AID - 10.1007/s10151-019-02051-5 [pii]
AID - 2051 [pii]
AID - 10.1007/s10151-019-02051-5 [doi]
PST - ppublish
SO  - Tech Coloproctol. 2019 Aug;23(8):729-741. doi: 10.1007/s10151-019-02051-5. Epub 
      2019 Jul 31.