Clinicopathological determinants of recurrence after surgical treatment of fistula‐in‐ano in a Ghanaian teaching hospital

Abstract Aim The aim of this work is to describe the clinicopathological and surgical aspects of fistula‐in‐ano and assess the risks associated with recurrence of the disease in a Ghanaian teaching hospital. Method This was a retrospective observational study assessing all fistula‐in‐ano surgeries performed at the Korle Bu Teaching hospital from January 2014 to January 2021 that had completed follow up of at least 3 months after wound healing. Demographic, clinical, pathological and surgical data were extracted from patient records. Logistic regression analysis was used to test for association between these variables and recurrence. Results A total of 105 patients underwent 124 fistula surgeries. Their median age was 41 years, the male:female ratio was 4:1 and 12 had comorbidities including human immunodeficiency virus infection and diabetes mellitus. Thirty‐one per cent (39/124) of fistulas had previously been operated on. At surgery, 51% (64/124) of fistulas followed a single straight tract, 30% (37/124) a single curved tract and 19% (23/124) had multiple curved tracts. More than half (65/124) were trans‐sphincteric, 35% (44/124) suprasphincteric, 10% (12/124) subsphincteric and 2% (3/124) were intersphincteric. Sixty per cent of fistulas were treated with a ligation of intersphincteric fistula tract (74/124), 35% (44/124) a fistulectomy and 5% a fistulotomy. Recurrence after surgery was 22.5% (28/124); this was significantly higher for fistulas with multiple curved tracts (OR 4.153, 95% CI 1.431–12.054, p = 0.012) and fistulas with comorbidities (OR 3.222, 95% CI 1.076–9.647, p = 0.037). Conclusion There was high recurrence after fistula surgery with increased risk for fistulas with multiple tracts and the presence of comorbidities.