Analysis Of Risk Factors For Postoperative Recurrence Of Complex Anal Fistula

Objective:Objective to analyze and explore the risk factors of postoperative recurrence of complex anal fistula,so as to identify high-risk patients,strengthen patient management,and provide scientific basis for reducing recurrence。Methods:A total of 375 patients with complicated anal fistula who were admitted to the people’s Hospital of Shanxi Medical University between January 2018 and January 2020 were retrospectively enrolled in this study.The related factors that may affect postoperative recurrence were collected for analysis: sex,age,smoking history,surgical history of anal fistula,location of fistula,distribution of internal mouth,diabetes mellitus history,presence of pus,onset to operation time,intraoperative hanging wire 10 indicators,univariate and logistic multivariate regression analysis were used to explore the risk factors causing postoperative recurrence of complicated anal fistula.Results:Twenty six recurrences in 331 patients followed up for a recurrence rate of7.9%.Comorbid diabetes mellitus(P = 0.013),previous surgical history of anal fistula(P< 0.001),high anal fistula(P = 0.023),onset to surgery time greater than 3 months(P =0.006)were higher in patients than in the general population,and internal mouth orientation was also a risk factor for recurrence of anal fistula(P = 0.002)with statistical significance.Logistic multiple regression analysis revealed that a history of surgery for anal fistula(O(?)R = 5.325,95% CI 2.070-13.837)and an unclear orientation of the internal os were both independent risk factors for postoperative recurrence of anal fistula.Whereas,low-lying anal fistula(O(?)R = 0.397,95% CI 0.159-0.986)and a clear internal mouth orientation were protective factors in anal fistula recurrence.Conclusion:Surgical history of anal fistula,onset to operation time,location of internal mouth,and orientation of internal mouth were all independent factors affecting the recurrence of complex anal fistula.Patients with a confirmed surgical history of anal fistula,especially combined with anal fistula,should be operated on as early as possible,and all the internal mouth locations should be fully defined intraoperatively,the fistula should be completely removed,and after operation,actively promote wound growth and healing,and reduce the risk of recurrence.