Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2021; 13(4): 340-354
Published online Apr 27, 2021. doi: 10.4240/wjgs.v13.i4.340
Lessons learned from an audit of 1250 anal fistula patients operated at a single center: A retrospective review
Pankaj Garg, Baljit Kaur, Ankita Goyal, Vipul D Yagnik, Sushil Dawka, Geetha R Menon
Pankaj Garg, Department of Colorectal Surgery, Garg Fistula Research Institute, Panchkula 134113, Haryana, India
Pankaj Garg, Department of Colorectal Surgery, Indus International Hospital, Mohali 140201, Punjab, India
Baljit Kaur, Department of Radiology, SSRD Magnetic Resonance Imaging Institute, Chandigarh 160011, Chandigarh, India
Ankita Goyal, Department of Pathology, Gian Sagar Medical College and Hospital, Patiala 140601, Punjab, India
Vipul D Yagnik, Department of Surgical Gastroenterology, Nishtha Surgical Hospital and Research Center, Patan 384265, Gujarat, India
Sushil Dawka, Department of Surgery, SSR Medical College, Belle Rive 744101, Mauritius
Geetha R Menon, Department of Statistics, Indian Council of Medical Research, New Delhi 110029, New Delhi, India
Author contributions: Garg P conceived and designed the study, collected and analyzed the data, and revised the data (Guarantor of the review); Kaur B, Goyal A and Yagnik VD collected and analyzed the data, and revised the data; Dawka S critically analyzed the data, reviewed, and edited the manuscript; Menon GR analyzed and revised the data; All authors finally approved and submitted the manuscript.
Institutional review board statement: The study was reviewed and approved by the Indus International Hospital-Institute Ethics Committee (approval number EC/IIH-IEH/SP6).
Informed consent statement: All study participants or their legal guardian provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author, Pankaj Garg at drgargpankaj@yahoo.com.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Pankaj Garg, MD, MS, Chief Surgeon, Department of Colorectal Surgery, Garg Fistula Research Institute, 1042/15, Panchkula 134113, Haryana, India. drgargpankaj@yahoo.com
Received: December 28, 2020
Peer-review started: December 28, 2020
First decision: January 18, 2021
Revised: January 18, 2021
Accepted: March 29, 2021
Article in press: March 29, 2021
Published online: April 27, 2021
Core Tip

Core Tip: This is the largest anal fistula study reported to date, with 1351 procedures performed in 1250 patients over 14 years at an exclusive fistula-care center. A treatment algorithm was consistently followed. Fistulotomy was done for simple fistulas, and a novel sphincter-sparing procedure, transanal opening of intersphincteric space, was performed for complex high fistulas. The overall success rate was 93.5% in all fistulas, 98.6% for simple fistulas, and 86% in complex high fistulas. Fistulas associated with abscesses were managed safely and successfully by definitive surgery on the first attempt . Several novel concepts were developed during the study.