Length of follow-up after fistulotomy and fistulectomy associated with endorectal advancement flap repair for fistula in ano

Background: The length of follow-up required after surgical repair of cryptoglandular fistula in ano has not been established. This prospective study determined the follow-up time needed to establish that an anal fistula has been cured after elective fistulotomy or fistulectomy associated with endorectal advancement flap (ERAF) repair. Methods: Between January 2001 and June 2004, consecutive patients with anal fistula of cryptoglandular aetiology were included provided that they lived within the catchment area of the hospital and agreed to participate in a follow-up programme, which comprised scheduled visits every month until complete wound healing and annually thereafter. Results: Some 206 of 219 eligible patients were evaluable; fistulotomy was performed in 115 and ERAF repair in 91. Median follow-up was 42 (range 24-65) months. Eighteen patients had recurrence of the fistula during follow-up, with a median time to relapse of 5.0 (range 1.0-11.7) months. There were no recurrences after 1 year. Conclusion: Recurrence of fistula in ano of cryptoglandular origin treated by means of fistulotomy or ERAF repair occurs within the first year of operation.