Background: Tuberculosis-associated anal fistula presents diagnostic and surgical challenges. Its prevalence and impact on outcomes remain underexplored. This study analysed the prevalence, diagnostic reliability, surgical interventions and treatment outcomes in tuberculosis-associated anal fistula.
Aims & Objectives: The objective of this study was to determine (a) the prevalence of tuberculosis in anal fistula (b) assess diagnostic test concordance (c) evaluate surgical outcomes (d) recurrence rates and (e) analyse the impact of anti-tubercular therapy completion.
Materials and Methods: This study employs a retrospective cohort design to analyse the outcomes of patients surgically treated for anorectal fistula secondary to tuberculosis. A total of 31 patients, treated between December 2021 and January 2025, were included in the analysis. Tuberculosis status was determined via Mantoux, PUS-TB-PCR, PUS-CBNAAT, Fistula-CBNAAT, TB-GOLD. Fistulae were classified into three categories: simple, complicated and horseshoe. Surgical interventions performed included laser-based surgery, fistulectomy and combined procedures. Outcomes were assessed based on the following criteria: disease-free, ongoing antitubercular therapy (ATT), lost to follow-up and persistent disease. Statistical analyses included McNemar’s test, Cohen’s Kappa, chi-square, Fisher’s exact, Mann-Whitney U (p < 0>
Results: Single openings were observed in 64.5% of cases, multiple openings in 32.3% and absent openings in 3.2% (p < 0 xss=removed xss=removed xss=removed xss=removed xss=removed xss=removed>
The overall disease-free rate was 22.6%. Tuberculosis-positive patients who completed their antitubercular therapy (ATT) achieved a 100% disease-free status (p = 0.001). In contrast, those with incomplete ATT had a 53.3% rate of persistent disease. Recurrence rates were 6.7% in tuberculosis-positive patients and 0% in tuberculosis-negative patients (p = 0.48).
Conclusion: Tuberculosis plays a significant role in the development of anal fistulae, with a similar prevalence observed within the cohort. The variability in diagnostic tests indicates the importance of a multi-disciplinary approach. Surgical outcomes are primarily influenced by the complexity of the fistula rather than the tuberculosis status of the patient. Complete adherence to antitubercular therapy (ATT) notably improves disease-free rates. These findings emphasize the necessity of preoperative tuberculosis screening and a collaborative, interdisciplinary management approach.
Keywords: Anal fistula, Tuberculosis, Perianal tuberculosis, Anti-tubercular therapy, Surgical outcomes, Recurrence, Fistulotomy, Laser therapy, Diagnostic accuracy, Chronic inflammation
