{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T10:51:33Z","timestamp":1793875893993,"version":"4.7.0"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,4,16]],"date-time":"2020-04-16T00:00:00Z","timestamp":1586995200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,4,16]],"date-time":"2020-04-16T00:00:00Z","timestamp":1586995200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>This retrospective observational study analyses the outcomes of patients undergoing surgery for anal fistula at a single centre in order to assess recurrence and re-operation rates after different surgical techniques. During January 2005 and May 2013, all patients with anal fistula were included. Baseline characteristics, details of presentation, fistula anatomy, type of surgery, post-surgical outcomes and follow-up data were collected. The primary endpoints were long-term closure rate and recurrence rate after 2 years. Secondary endpoints were persistent pain, postoperative complications and continence status. A total of 65 patients were included. From a total amount of 93 operations, 65 were fistulotomies, 13 mucosal advancement flaps, 7 anal fistula plugs and 8 cutting-setons. The mean follow up was 80 months. Healing was achieved in 85%. The highest recurrence rate was seen in anal fistula plug with 42%. On the other hand, no recurrence was observed in the cutting-seton procedures. For all included operation no persistent postoperative pain nor incontinence was observed. In conclusion, despite all existing anal fistula operations up to date, the optimal technique with low recurrence rate and assured safety for the anal sphincter is still lacking. Nonetheless, according to our promising results for the cutting-seton technique, this technique, otherwise considered obsolete, should be further evaluated in a prospective study.<\/jats:p>","DOI":"10.1038\/s41598-020-63541-3","type":"journal-article","created":{"date-parts":[[2020,4,16]],"date-time":"2020-04-16T10:03:11Z","timestamp":1587031391000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["Longterm outcome of anal fistula \u2013 A retrospective study"],"prefix":"10.1038","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6430-727X","authenticated-orcid":false,"given":"Christos","family":"Andreou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasmin","family":"Zeindler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Oertli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi","family":"Misteli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,4,16]]},"reference":[{"key":"63541_CR1","doi-asserted-by":"publisher","first-page":"1857","DOI":"10.1002\/bjs.10614","volume":"104","author":"K Sahnan","year":"2017","unstructured":"Sahnan, K. et al. Natural history of anorectal sepsis. Br. J. Surg. 104, 1857\u20131865 (2017).","journal-title":"Br. J. Surg."},{"key":"63541_CR2","doi-asserted-by":"publisher","unstructured":"Parks, A. G., Gordon, P. H. & Hardcastle, J. D. A classification of fistula\u2010in\u2010ano. Br. J. Surg., https:\/\/doi.org\/10.1002\/bjs.1800630102 (1976).","DOI":"10.1002\/bjs.1800630102"},{"key":"63541_CR3","first-page":"167","volume":"64","author":"C Belmonte Montes","year":"1999","unstructured":"Belmonte Montes, C., Ruiz Galindo, G. H., Montes Villalobos, J. L. & Decanini Teran, C. [Fistulotomy vs fistulectomy. Ultrasonographic evaluation of lesion of the anal sphincter function]. Rev. Gastroenterol. Mex. 64, 167\u2013170 (1999).","journal-title":"Ultrasonographic evaluation of lesion of the anal sphincter function]. Rev. Gastroenterol. Mex."},{"key":"63541_CR4","doi-asserted-by":"publisher","unstructured":"Ratto, C., Litta, F., Donisi, L. & Parello, A. Fistulotomy or fistulectomy and primary sphincteroplasty for anal fistula (FIPS): a systematic review. Techniques in Coloproctology, https:\/\/doi.org\/10.1007\/s10151-015-1323-4 (2015).","DOI":"10.1007\/s10151-015-1323-4"},{"key":"63541_CR5","doi-asserted-by":"publisher","first-page":"3665","DOI":"10.18203\/2349-2902.isj20174882","volume":"4","author":"H Anandan","year":"2017","unstructured":"Anandan, H. A comparative study between fistulotomy and fistulectomy in management of low anal fistulae. Int. Surg. J. Ganesan R 4, 3665\u20133669 (2017).","journal-title":"Int. Surg. J. Ganesan R"},{"key":"63541_CR6","doi-asserted-by":"publisher","unstructured":"Cariati, A. Fistulotomy or seton in anal fistula: A decisional algorithm. Updates Surg., https:\/\/doi.org\/10.1007\/s13304-013-0216-1 (2013).","DOI":"10.1007\/s13304-013-0216-1"},{"key":"63541_CR7","doi-asserted-by":"publisher","unstructured":"van der Hagen, S. J., Baeten, C. G., Soeters, P. B. & van Gemert, W. G. Long-term outcome following mucosal advancement flap for high perianal fistulas and fistulotomy for low perianal fistulas: Recurrent perianal fistulas: Failure of treatment or recurrent patient disease? Int. J. Colorectal Dis., https:\/\/doi.org\/10.1007\/s00384-005-0072-7 (2006).","DOI":"10.1007\/s00384-005-0072-7"},{"key":"63541_CR8","doi-asserted-by":"publisher","unstructured":"Van Koperen, P. J. et al. Long-term functional outcome and risk factors for recurrence after surgical treatment for low and high perianal fistulas of cryptoglandular origin. Dis. Colon Rectum, https:\/\/doi.org\/10.1007\/s10350-008-9354-9 (2008).","DOI":"10.1007\/s10350-008-9354-9"},{"key":"63541_CR9","doi-asserted-by":"publisher","unstructured":"G\u00f6ttgens, K. W. A. et al. Long-term outcome of low perianal fistulas treated by fistulotomy: a multicenter study. Int. J. Colorectal Dis., https:\/\/doi.org\/10.1007\/s00384-014-2072-y (2014).","DOI":"10.1007\/s00384-014-2072-y"},{"key":"63541_CR10","doi-asserted-by":"publisher","unstructured":"Williams, G. et al. The treatment of anal fistula: second ACPGBI Position Statement \u2013 2018. Color. Dis., https:\/\/doi.org\/10.1111\/codi.14054 (2018).","DOI":"10.1111\/codi.14054"},{"key":"63541_CR11","doi-asserted-by":"publisher","unstructured":"Visscher, A. P. et al. Long-term follow-up after surgery for simple and complex cryptoglandular fistulas: Fecal incontinence and impact on quality of life. Dis. Colon Rectum, https:\/\/doi.org\/10.1097\/DCR.0000000000000352 (2015).","DOI":"10.1097\/DCR.0000000000000352"},{"key":"63541_CR12","doi-asserted-by":"publisher","unstructured":"Mitalas, L. E., Gosselink, M. P., Oom, D. M. J., Zimmerman, D. D. E. & Schouten, W. R. Required length of follow-up after transanal advancement flap repair of high transsphincteric fistulas. Color. Dis., https:\/\/doi.org\/10.1111\/j.1463-1318.2008.01666.x (2009).","DOI":"10.1111\/j.1463-1318.2008.01666.x"},{"key":"63541_CR13","doi-asserted-by":"publisher","first-page":"1537","DOI":"10.1097\/DCR.0b013e31822d7ddd","volume":"54","author":"A Jarrar","year":"2011","unstructured":"Jarrar, A. & Church, J. Advancement flap repair: a good option for complex anorectal fistulas. Dis. Colon Rectum 54, 1537\u20131541 (2011).","journal-title":"Dis. Colon Rectum"},{"key":"63541_CR14","doi-asserted-by":"publisher","unstructured":"Christoforidis, D., Pieh, M. C., Madoff, R. D. & Mellgren, A. F. Treatment of transsphincteric anal fistulas by endorectal advancement flap or collagen fistula plug: A comparative study. Dis. Colon Rectum, https:\/\/doi.org\/10.1007\/DCR.0b013e31819756ac (2009).","DOI":"10.1007\/DCR.0b013e31819756ac"},{"key":"63541_CR15","doi-asserted-by":"publisher","unstructured":"Ommer, A. et al. S3 guidelines: cryptoglandular anal fistulas. 2. revised version, The German Association of Scientific Medical Societies registration number: 088\/003. Coloproctology, https:\/\/doi.org\/10.1007\/s00053-016-0110-7 (2017).","DOI":"10.1007\/s00053-016-0110-7"},{"key":"63541_CR16","doi-asserted-by":"publisher","unstructured":"Ortiz, H. et al. Randomized clinical trial of anal fistula plug versus endorectal advancement flap for the treatment of high cryptoglandular fistula in ano. Br. J. Surg., https:\/\/doi.org\/10.1002\/bjs.6613 (2009).","DOI":"10.1002\/bjs.6613"},{"key":"63541_CR17","doi-asserted-by":"publisher","unstructured":"Schwandner, T. et al. Surgical treatment of complex anal fistulas with the anal fistula plug: A prospective, multicenter study. Dis. Colon Rectum, https:\/\/doi.org\/10.1007\/DCR.0b013e3181a8fbb7 (2009).","DOI":"10.1007\/DCR.0b013e3181a8fbb7"},{"key":"63541_CR18","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1111\/codi.12594","volume":"16","author":"M Adamina","year":"2014","unstructured":"Adamina, M. et al. Anal fistula plug: A prospective evaluation of success, continence and quality of life in the treatment of complex fistulae. Color. Dis. 16, 547\u2013554 (2014).","journal-title":"Color. Dis."},{"key":"63541_CR19","doi-asserted-by":"publisher","unstructured":"Vial, M., Par\u00e9s, D., Pera, M. & Grande, L. Faecal incontinence after seton treatment for anal fistulae with and without surgical division of internal anal sphincter: A systematic review. Colorectal Disease, https:\/\/doi.org\/10.1111\/j.1463-1318.2009.01810.x (2010).","DOI":"10.1111\/j.1463-1318.2009.01810.x"},{"key":"63541_CR20","doi-asserted-by":"publisher","unstructured":"Rosen, D. R. & Kaiser, A. M. Definitive seton management for transsphincteric fistula-in-ano: Harm or charm? Color. Dis., https:\/\/doi.org\/10.1111\/codi.13120 (2016).","DOI":"10.1111\/codi.13120"},{"key":"63541_CR21","doi-asserted-by":"publisher","first-page":"12","DOI":"10.3748\/wjg.v21.i1.12","volume":"21","author":"E Limura","year":"2015","unstructured":"Limura, E. & Giordano, P. Modern management of anal fistula. World J. Gastroenterol. 21, 12\u201320 (2015).","journal-title":"World J. Gastroenterol."},{"key":"63541_CR22","doi-asserted-by":"publisher","unstructured":"Ritchie, R. D., Sackier, J. M. & Hodde, J. P. Incontinence rates after cutting seton treatment for anal fistula. Colorectal Disease, https:\/\/doi.org\/10.1111\/j.1463-1318.2008.01713.x (2009).","DOI":"10.1111\/j.1463-1318.2008.01713.x"},{"key":"63541_CR23","doi-asserted-by":"publisher","first-page":"1231","DOI":"10.1097\/DCR.0000000000001448","volume":"62","author":"KWA G\u00f6ttgens","year":"2019","unstructured":"G\u00f6ttgens, K. W. A., Wasowicz, D. K., Stijns, J. & Zimmerman, D. Ligation of the Intersphincteric Fistula Tract for High Transsphincteric Fistula Yields Moderate Results at Best: Is the Tide Turning? Dis. Colon Rectum 62, 1231\u20131237 (2019).","journal-title":"Dis. Colon Rectum"},{"key":"63541_CR24","doi-asserted-by":"publisher","first-page":"532","DOI":"10.5966\/sctm.2014-0199","volume":"4","author":"YB Cho","year":"2015","unstructured":"Cho, Y. B. et al. Long-Term Results of Adipose-Derived Stem Cell Therapy for the Treatment of Crohn\u2019s Fistula. Stem Cells Transl. Med. 4, 532\u2013537 (2015).","journal-title":"Stem Cells Transl. Med."},{"key":"63541_CR25","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1007\/s10151-017-1599-7","volume":"21","author":"A Wilhelm","year":"2017","unstructured":"Wilhelm, A., Fiebig, A. & Krawczak, M. Five years of experience with the FiLaCTM laser for fistula-in-ano management: long-term follow-up from a single institution. Tech. Coloproctol. 21, 269\u2013276 (2017).","journal-title":"Tech. Coloproctol."},{"key":"63541_CR26","doi-asserted-by":"publisher","first-page":"2084","DOI":"10.1007\/s00464-017-5905-2","volume":"32","author":"SH Emile","year":"2018","unstructured":"Emile, S. H., Elfeki, H., Shalaby, M. & Sakr, A. A Systematic review and meta-analysis of the efficacy and safety of video-assisted anal fistula treatment (VAAFT). Surg. Endosc. 32, 2084\u20132093 (2018).","journal-title":"Surg. Endosc."},{"key":"63541_CR27","doi-asserted-by":"publisher","unstructured":"Quah, H. M., Tang, C. L., Eu, K. W., Chan, S. Y. E. & Samuel, M. Meta-analysis of randomized clinical trials comparing drainage alone vs primary sphincter-cutting procedures for anorectal abscess-fistula. Int. J. Colorectal Dis., https:\/\/doi.org\/10.1007\/s00384-005-0060-y (2006).","DOI":"10.1007\/s00384-005-0060-y"},{"key":"63541_CR28","doi-asserted-by":"publisher","unstructured":"Khafagy, W. et al. Treatment of anal fistulas by partial rectal wall advancement flap or mucosal advancement flap: A prospective randomized study. Int. J. Surg., https:\/\/doi.org\/10.1016\/j.ijsu.2010.03.009 (2010).","DOI":"10.1016\/j.ijsu.2010.03.009"},{"key":"63541_CR29","doi-asserted-by":"crossref","unstructured":"Safar, B. et al. Anal Fistula Plug: Initial Experience and Outcomes. Dis. Colon Rectum 52 (2009).","DOI":"10.1007\/DCR.0b013e31819c96ac"},{"key":"63541_CR30","doi-asserted-by":"publisher","unstructured":"Soliman, F., Sturgeon, G. & Hargest, R. Revisiting an ancient treatment for transphincteric fistula-in-ano \u2018There is nothing new under the sun\u2019 Ecclesiastes 1v9. J. R. Soc. Med., https:\/\/doi.org\/10.1177\/0141076815588322 (2015).","DOI":"10.1177\/0141076815588322"},{"key":"63541_CR31","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3310\/hta23210","volume":"23","author":"DG Jayne","year":"2019","unstructured":"Jayne, D. G. et al. Anal fistula plug versus surgeon\u2019s preference for surgery for trans-sphincteric anal fistula: The FIAT RCT. Health Technol. Assess. (Rockv). 23, 1\u201375 (2019).","journal-title":"Health Technol. Assess. (Rockv)."},{"key":"63541_CR32","first-page":"153","volume":"69","author":"Z Mei","year":"2019","unstructured":"Mei, Z. et al. Risk Factors for Recurrence after anal fistula surgery: A meta-analysis. International. Journal of Surgery 69, 153\u2013164 (2019).","journal-title":"Journal of Surgery"},{"key":"63541_CR33","doi-asserted-by":"publisher","unstructured":"Ky, A. J. et al. Collagen Fistula Plug for the treatment of anal fistulas. Dis. Colon Rectum, https:\/\/doi.org\/10.1007\/s10350-007-9191-2 (2008).","DOI":"10.1007\/s10350-007-9191-2"},{"key":"63541_CR34","doi-asserted-by":"publisher","unstructured":"Chung, W. et al. Anal fistula plug and fibrin glue versus conventional treatment in repair of complex anal fistulas. Am. J. Surg., https:\/\/doi.org\/10.1016\/j.amjsurg.2008.12.013 (2009).","DOI":"10.1016\/j.amjsurg.2008.12.013"},{"key":"63541_CR35","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1007\/BF02050307","volume":"36","author":"JMN Jorge","year":"1993","unstructured":"Jorge, J. M. N. & Wexner, S. D. Etiology and management of fecal incontinence. Dis. Colon Rectum 36, 77\u201397 (1993).","journal-title":"Dis. Colon Rectum"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-020-63541-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-020-63541-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-020-63541-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,6]],"date-time":"2022-12-06T09:42:00Z","timestamp":1670319720000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-020-63541-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,4,16]]},"references-count":35,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,12]]}},"alternative-id":["63541"],"URL":"https:\/\/doi.org\/10.1038\/s41598-020-63541-3","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,4,16]]},"assertion":[{"value":"4 October 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 March 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 April 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"6483"}}