Operative Management of Anal Fistula in Lagos: Outcomes and Complications

BACKGROUND: Fistula-in-ano (FIA) describes an anal condition in which there is a connecting tract between the perianal skin and the lining of the anal canal. Surgery is the mainstay of treatment. Disease recurrence and anal incontinence are major concerns in surgery for FIA. The conventional fistulotomy and fistulectomy have demonstrated superiority over the endoscopic and other sphincter-sparing treatments for FIA. AIMS: The study aimed at reporting our experiences of surgery for fistula-in-ano. There is a scarcity of local studies on FIA in Nigeria, hence the need to report our experience with surgery for FIA. METHODOLOGY: This is a retrospective review of available records of FIA cases in patients aged 16 years or more managed between February 2016 and February 2025. Information on demographical characteristics, clinical/radiological features and the type and number of surgical treatments for complete healing were retrieved from the records for analysis. Excluded from this study were patients with incomplete records and patients with secondary fistulae. Data analysis was performed using SPSS. RESULTS: We analysed records of 30 cases of FIA. There were 24 males (80%) and 6 females (20%) giving a ratio of 4:1. The mean age of all patients was 40.8 ± 10.8 years (range: 24-60 years). The modal age group was between 30 and 39 years. Twenty-seven cases (90%) were primary FIA; all patients presented with recurrent anal discharge of pus. Twenty-three patients (76.6%) presented with perianal pain. The number of external openings recorded was single in 22 patients (76.6%). Three patients presented with horseshoe-type FIA. Low-type fistula accounted for 90% of cases. Surgical treatments offered were anal fistulectomy in 11 patients (36.7%), partial fistulectomy and insertion of cutting seton in 11 (36.7%) patients, anal fistulotomy in seven patients (23.3%). Procedure-related complications occurred in six patients (20%). Occasional faecal incontinence was documented by two patients (6.7%). Recurrence after healing of the fistula tract was seen in two patients (6.7%). CONCLUSION: FIA occurs mostly in males; the majority are of low posterior type. Surgical deroofing or excision of the tract with surgical or seton fistulotomy has a good success rate. It is recommended as the first line of treatment in low-resource settings.