Annals of Coloproctology

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Original Articles

Benign proctology

Long-term outcomes after anal fistula surgery: results from two university hospitals in Thailand: Weeraput Chadbunchachai, Varut Lohsiriwat, Krisada Paonariang; Ann Coloproctol. 2022;38(2):133-140. Published online June 7, 2021; DOI: https://doi.org/10.3393/ac.2021.01.06

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217 Download
6 Web of Science
4 Citations

Purpose
This study aimed to evaluate long-term outcomes after anal fistula surgery from university hospitals in Thailand.
Methods
A prospectively collected database of patients with cryptoglandular anal fistula undergoing surgery from 2011 to 2017 in 2 university hospitals was reviewed. Outcomes were treatment failure (persistent or recurrent fistula), fecal continence status, and chronic postsurgical pain.
Results
This study included 247 patients; 178 (72.1%) with new anal fistula and 69 (27.9%) with recurrent fistula. One hundred twenty-one patients (49.0%) had complex fistula; 53 semi-horseshoe (21.5%), 41 high transsphincteric (16.6%), 24 horseshoe (9.7%), and 3 suprasphincteric (1.2%). Ligation of intersphincteric fistula tract (LIFT) was the most common operation performed (n=88, 35.6%) followed by fistulotomy (n=79, 32.0%). With a median follow-up of 23 months (interquartile range, 12–45 months), there were 18 persistent fistulas (7.3%) and 33 recurrent fistulae (13.4%)—accounting for 20.6% overall failure. All recurrence occurred within 24 months postoperatively. Complex fistula was the only significant predictor for recurrent fistula with a hazard ratio of 4.81 (95% confidence interval, 1.82–12.71). There was no significant difference in healing rates of complex fistulas among seton staged fistulotomy (85.0%), endorectal advancement flap (72.7%), and LIFT (65.9%) (P=0.239). Four patients (1.6%) experienced chronic postsurgical pain. Seventeen patients (6.9%) reported worse fecal continence.
Conclusion
Overall failure for anal fistula surgery was 20.6%. Complex fistula was the only predictor for recurrent fistula. At least 2-year period of follow-up is suggested for detecting recurrent diseases and assessing patient-reported outcomes such as chronic pain and continence status.

Citations

Citations to this article as recorded by

The Clinical Utility of Anorectal Manometry: A Review of Current Practices
Eleanor Aubrey Belilos, Zoë Post, Sierra Anderson, Mark DeMeo
Gastro Hep Advances.2025; 4(2): 100562. CrossRef
Mucosal advancement flap versus ligation of the inter-sphincteric fistula tract for management of trans-sphincteric perianal fistulas in the elderly: a retrospective study
Tamer A. A. M. Habeeb, Massimo Chiaretti, Igor A. Kryvoruchko, Antonio Pesce, Aristotelis Kechagias, Abd Al-Kareem Elias, Abdelmonem A. M. Adam, Mohamed A. Gadallah, Saad Mohamed Ali Ahmed, Ahmed Khyrallh, Mohammed H. Alsayed, Esmail Tharwat Kamel Awad, M
International Journal of Colorectal Disease.2025;[Epub] CrossRef
Exploring Health-Related Quality of Life in Patients with Anal Fistulas: A Comprehensive Study
Tudor Mateescu, Lazar Fulger, Durganjali Tummala, Aditya Nelluri, Manaswini Kakarla, Lavinia Stelea, Catalin Dumitru, George Noditi, Amadeus Dobrescu, Cristian Paleru, Ana-Olivia Toma
Life.2023; 13(10): 2008. CrossRef
Lower Fistula Recurrence with Pulling Seton: A Retrospective Cohort Study
Ahmad Izadpanah, Ali Reza Safarpour, Mohammad Rezazadehkermani, Ali Zahedian, Reza Barati-Boldaji
Shiraz E-Medical Journal.2022;[Epub] CrossRef

Benign GI diease,Benign diesease & IBD,Complication

High Compliance With Surgical Site Infection (SSI) Prevention Bundle Reduces Incisional SSI After Colorectal Surgery: Varut Lohsiriwat; Ann Coloproctol. 2021;37(3):146-152. Published online May 15, 2020; DOI: https://doi.org/10.3393/ac.2020.04.10.2

6,274 View
256 Download
11 Web of Science
11 Citations

Abstract PDF

Purpose
This study aimed to evaluate association between compliance with surgical site infection (SSI) prevention bundle and the development of superficial or deep incisional SSI following colorectal surgery and to evaluate the impact of incisional SSI on surgical outcomes.
Methods
A prospectively collected database of consecutive patients undergoing elective colectomy and/or proctectomy from 2011 to 2019 in a university hospital was reviewed. The association between compliance with Thailand’s SSI Prevention Bundle (10 level-1A interventions) and the incidence of incisional SSI was determined. Surgical outcomes were compared between those with incisional SSI and those without.
Results
This study included 600 patients with a median age of 64 years (range, 18–102 years). Some 126 patients (21.0%) had stoma formation and 52 (8.7%) underwent laparoscopy. The incidence of incisional SSI was 5.5% (n = 33; 32 superficial incisional SSI and 1 deep incisional SSI). Higher compliance with care bundle tended to decrease incisional SSI (P = 0.20). In multivariate analysis, compliance of 70% or more was the only dependent factor for reducing incisional SSI (odds ratio, 0.39; 95% confidence interval, 0.15 to 0.99; P = 0.047). None of individual interventions were significantly associated with a lower probability of incisional SSI. Compared with counterparts, patients with incisional SSI had a 2-day longer length of postoperative stay (6 day vs. 4 day, P < 0.001) but comparable time for gastrointestinal recovery and similar rate of 30-day mortality or readmission.
Conclusion
High compliance with SSI prevention bundle (especially ≥ 70%) reduced incisional SSI after colorectal surgery.

Citations

Citations to this article as recorded by

Surgical site infection prevention care bundles in colorectal surgery: a scoping review
T. Cunha, S. Miguel, J. Maciel, C. Zagalo, P. Alves
Journal of Hospital Infection.2025; 155: 221. CrossRef
Empowering patients through a perioperative prevention bundle to reduce surgical site infections in colorectal surgery
Vladimir Nikolic, Ljiljana Markovic-Denic, Stefan Kmezic, Aleksandar Radovanovic, Djordje Nektarijevic, Jelena Djokic-Kovac, Djordje Knezevic, Andrija Antic
American Journal of Infection Control.2025; 53(7): 753. CrossRef
Surgical Site Infection Prevention Using “Strike Teams”: The Experience of an Academic Colorectal Surgical Department
Buddhi Hatharaliyadda, Michelle Schmitz, Anne Mork, Fauzia Osman, Charles Heise, Nasia Safdar, Aurora Pop-Vicas
Journal for Healthcare Quality.2024; 46(1): 22. CrossRef
Interventions to reduce surgical site infection following elective colorectal surgery: protocol for a systematic review with narrative synthesis and GRADE recommendations
Harry Dean, Ioanna Drami, Amira Shamsiddinova, Eman Alkizwini, James Kinross, Ana Wilson, Phil Tozer, Carolynne Vaizey
Journal of Surgical Protocols and Research Methodologies.2024;[Epub] CrossRef
Effect of a colorectal bundle in an entire healthcare region in Switzerland: results from a prospective cohort study (EvaCol study)
Benjamin Wiesler, Robert Rosenberg, Raffaele Galli, Jürg Metzger, Mathias Worni, Mark Henschel, Mark Hartel, Christian Nebiker, Carsten T. Viehl, Alexandra Müller, Lukas Eisner, Martina Pabst, Urs Zingg, Daniel Stimpfle, Beat P. Müller, Markus von Flüe, R
International Journal of Surgery.2024; 110(12): 7763. CrossRef
Information technologies for supporting prevention, diagnosis and management of surgical site infections in trauma and orthopedic patients
Anton G. Nazarenko, Elena B. Kleimenova, Mikhail A. Dronov, Dmitry S. Gorbatyuk, Nodari M. Kakabadze, Archil V. Tsiskarashvili, Natalia P. Gerasimova, Ekaterina S. Yurchenkova, Liubov P. Yashina
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Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons
Jennifer L. Irani, Traci L. Hedrick, Timothy E. Miller, Lawrence Lee, Emily Steinhagen, Benjamin D. Shogan, Joel E. Goldberg, Daniel L. Feingold, Amy L. Lightner, Ian M. Paquette
Diseases of the Colon & Rectum.2023; 66(1): 15. CrossRef
Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons
Jennifer L. Irani, Traci L. Hedrick, Timothy E. Miller, Lawrence Lee, Emily Steinhagen, Benjamin D. Shogan, Joel E. Goldberg, Daniel L. Feingold, Amy L. Lightner, Ian M. Paquette
Surgical Endoscopy.2023; 37(1): 5. CrossRef
The Latest Results and Future Directions of Research for Enhanced Recovery after Surgery in the Field of Colorectal Surgery
Min Ki Kim
The Ewha Medical Journal.2023;[Epub] CrossRef
Strategies to Reduce Post-Hemorrhoidectomy Pain: A Systematic Review
Varut Lohsiriwat, Romyen Jitmungngan
Medicina.2022; 58(3): 418. CrossRef
Robot-Assisted Colorectal Surgery
Young Il Kim
The Ewha Medical Journal.2022;[Epub] CrossRef

Review

Malignant disease, Rectal cancer

Current Colorectal Cancer in Thailand: Varut Lohsiriwat, Nopdanai Chaisomboon, Jirawat Pattana-Arun, for the Society of Colorectal Surgeons of Thailand; Ann Coloproctol. 2020;36(2):78-82. Published online January 31, 2020; DOI: https://doi.org/10.3393/ac.2020.01.07

11,238 View
318 Download
19 Web of Science
17 Citations

Abstract PDF

This article aimed to summarize the current status of colorectal cancer (CRC) in Thailand. In brief, CRC is the third most common cancer and accounts for 11% of the cancer burden in Thailand. It is the only malignancy with an increased incidence in both sexes in Thailand. Over 10,000 new CRC cases occur annually, and about 40% are rectal cancer. Due to the lack of CRC screening and public awareness, nonmetastatic cancer accounts only for 60%–70% of overall cases. The demand for general or colorectal surgeons outmatches the supply at a ratio of 1 general surgeon to 35,000 individuals. There are about 70 board-certified colorectal surgeons serving Thailand’s population of nearly 70 million. As a result, >25% of cancer patients wait more than 1 month before surgery. Regarding training for colorectal surgery, there are 3 major institutes in Bangkok providing a 2-year fellowship program. Cadaveric workshops are an important part of training – especially in laparoscopy for CRC. Recently, a population-based CRC screening program was launched using a fecal immunochemical test. The Ministry of Public Health of Thailand has established additional platforms for laparoscopy to support the potential detection of early CRC following implementation of this nationwide screening program.

Citations

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