Prospective Study of Functional Disorders and Quality of Life Following Surgical Management of Perianal Fistulas

Background

Perianal fistulas are abnormal tracts that connect the anal canal or rectum to the perianal skin, most often developing after a perianal abscess that originates near the anal glands at the dentate line. The majority of fistulas arise secondary to an abscess. Treatment aims to eradicate the tract, prevent recurrence, and preserve continence by protecting the sphincter mechanism. Fistulas are classified anatomically (Parks) and, more clinically, as simple (low) or complex. Simple fistulas involve only the distal third of the external sphincter and are usually cured with sphincter-dividing procedures such as fistulotomy or fistulectomy, which have high healing rates and low continence risk. Complex fistulas-those that affect a larger portion of the sphincter, have multiple tracts, or are recurrent-require sphincter-preserving techniques (e.g., mucosal advancement flap, LIFT, laser treatment, plugs, or setons), although these approaches often carry higher recurrence rates. Current guidelines are hampered by limited high-quality evidence and marked heterogeneity in outcome definitions, measurement tools, and reporting practices, highlighting the need for standardized prospective data.

Study Objective and Design

The primary aim is to generate high-quality, real-world observational data on surgical management of perianal fistulas. We will conduct a prospective, multicenter cohort study enrolling adult patients at the time of definitive fistula surgery and following them for 12 months. The cohort will be stratified by fistula complexity (simple vs. complex) and by surgical strategy (partially sphincter-dividing versus sphincter-preserving). The study will capture demographic, clinical, imaging, and operative information to explore how these variables relate to healing, recurrence, continence preservation, and patient-reported quality of life.

Data Collection and Analysis