Epidemiology of Anal Fistulas: Experience of the Proctology Department of the Mohamed V Military Teaching Hospital in Rabat, Morocco (2020-2024)

Abstract

Anal fistulas are a common pathology in proctology, responsible for significant morbidity. The objective of this study was to describe the epidemiological, clinical, and therapeutic characteristics of anal fistulas treated in the Proctology Department of the Mohamed V Military Teaching Hospital in Rabat, Morocco. A 5-year retrospective descriptive study was conducted from January 2020 to December 2024. All patients presenting for anal fistula and treated in the department were included. Demographic data, history, fistula characteristics (Parks classification), additional examinations, treatment modalities, and postoperative complications were collected and analyzed. During the study period, 620 patients were included. The mean age was 46.6 years (SD ±  13.65), with a male predominance of 7:1. The most common antecedents were anal abscess in 42% of cases. According to the Parks classification, transsphincteric fistulas accounted for 67% of cases, intersphincteric for 26%, suprasphincteric for 5%, and extrasphincteric for 2%. Pelvic MRI was performed in 33% of patients, confirming the fistulous trajectory in 100% of cases. The most commonly used surgical treatments were seton drainage, fistulectomy, and FILAC. Initial cure was achieved in 89% of patients, recurrence in 11%, and the complication rate was less than 1%. Our series shows that the management of anal fistulas in the Proctology Department of the Mohamed V Military Teaching Hospital in Rabat follows international trends: predominance of transsphincteric and intersphincteric fistulas, increasing use of sphincter-sparing techniques, and the need for preoperative imaging to improve assessment. Prospective multicenter studies would be useful to refine the prognostic factors for recurrence and incontinence.