FISSIT (Fistula Surgery in Italy) study: A retrospective survey on the surgical management of anal fistulas in Italy over the last 15 years

Carlo Ratto, Francesco Litta, Angelo Parello, Salvatore Bracchitta, Gabriele Naldini, Massimiliano Mistrangelo, Nicola Tricomi, Marco La Torre, Donato Francesco Altomare, Marta Mozzon, Alessandro Testa, Daniele Zigiotto, Giuseppe Sica, Roberta Tutino, Giorgio Lisi, Fabio Marino, Gaetano Luglio, Roberto Vergari, Giovanni Terrosu, Francesco CantarellaNicola Foti, Antonio Giuliani, Veronica De Simone, Luigi Bracchitta, Alessandro Sturiale, Giacomo Lo Secco, Sara Salomone, Luigi Velci, Arcangelo Picciariello, Vincenzo Papagni, Filippo Caponnetto, Cristina Folliero, Tiziana Cozza, Fulvio Leopardi, Michela Campanelli, Andrea Divizia, Gianfranco Cocorullo, Elio D'Agostino, Massimiliano Boccuzzi, Francesco Pezzolla, Gianluca Pagano, Stefano Mancini, Monica Ortenzi, Sergio Calandra, Edoardo Scarpa, Enrico Magni, Fabio Cesare Campanile, Lucia Romano, Francesco Maffione, Simone Maria Tierno, Roberto Peltrini

Research output: Contribution to journalArticle


Background: Surgical treatment of anal fistulas is still a challenge. The aims of this study were to evaluate the adoption and healing rates for the different surgical techniques used in Italy over the past 15 years. Methods: This was a multicenter retrospective observational study of patients affected by simple and complex anal fistulas of cryptoglandular origin who were surgically treated in the period 2003–2017. Surgical techniques were grouped as sphincter-cutting or sphincter-sparing and as technology-assisted or techno-free. All patients included in the study were followed for at least 12 months. Results: A total of 9,536 patients (5,520 simple; 4,016 complex fistulas) entered the study. For simple fistulas, fistulotomy was the most frequently used procedure, although its adoption significantly decreased over the years (P < .0005), with an increase in sphincter-sparing approaches; the overall healing rate in simple fistulas was 81.1%, with a significant difference between sphincter-cutting (91.9%) and sphincter-sparing (65.1%) techniques (P = .001). For complex fistulas, the adoption of sphincter-cutting approaches decreased, while sphincter-sparing techniques were mildly preferred (P < .0005). Moreover, there was a significant trend toward the use of technology-assisted procedures. The overall healing rate for complex fistulas was 69.0%, with a measurable difference between sphincter-cutting (81.1%) and sphincter-sparing (61.4%; P = .001) techniques and between techno-free and technology-assisted techniques (72.5% and 55.0%, respectively; P = .001). Conclusion: Surgical treatment of anal fistulas has changed, with a trend toward the use of sphincter-sparing techniques. The overall cure rate has remained stable, even if the most innovative procedures have achieved a lower success rate.
Original languageEnglish
Pages (from-to)1-10
Number of pages10
Publication statusPublished - 2021


  • Anal fistula


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