Quality of life following fistulotomy - short term follow-up

Abstract

INTRODUCTION: Anal fistula causes pain, discharge of pus and blood. Fistulotomy has the highest success, however, can risk continence; treatment balances cure with continence. This study assessed the impact of fistulotomy on Quality Of Life (QOL) and continence. METHODS: Patients selected for fistulotomy prospectively completed St Mark's Continence Score (full incontinence = 24) and Short Form - 36 questionnaires pre-operatively at two institutions with an interest in anal fistula, and reassessed 3 months post-operatively. RESULTS: There were 52 patients median age 44, range 19 - 82 years, 10 were women. Pre-operative continence scores were median 0, range 0 - 23, there was no significant difference compared to post-operative scores, median 1, range 0-24. Quality of life was significantly improved following fistulotomy in 4 of 8 domains: Bodily Pain (p<0.001); Vitality (p<0.01); Social Functioning (p<0.05); Mental Health (p<0.001) and returned to that of the general population. QOL for patients with intersphincteric fistula improved post fistulotomy, for those with trans-sphincteric fistula QOL remained the same. Data were further examined in two groups, with and without continence score deterioration. Where continence improved post-operatively, QOL improved in 3 domains; where continence deteriorated QOL also improved, in 2 domains (p<0.05). Patients with post-operative continence of <5 points had worse QOL than those scoring 4 or less. DISCUSSION: QOL at three months follow up significantly improved following fistulotomy where continence was maintained or a small reduction occurred