Should we consider topical silver nitrate irrigation as a definitive nonsurgical treatment for perianal fistula?

Abstract

Background: Surgery is currently the sole treatment modality for anal fistulas. However, surgery is associated with complications such as permanent incontinence, which reduces quality of life.

Objective: To determine the rate of complete clinical healing of anal fistulas after irrigation of the fistula tract with silver nitrate solution as a nonsurgical treatment.

Design: Prospective single arm study.

Setting: Tertiary university hospital

Patients: : Adult patients with symptomatic perianal fistula presenting between June 2012 and January 2013.

Intervention: Irrigation of the fistula tract with 1% silver nitrate solution. Irrigation was repeated every 2 weeks when necessary.

Main outcome measures: The primary outcome measure was the rate of complete clinical healing.

Results: Fifty-six consecutive patients with anal fistula were analyzed. Of those, 29 (52%) had complete clinical healing without recurrence for a median of 10 months. The median number of irrigations needed for complete clinical healing was 4 (1-10). The level of satisfaction was excellent in patients with complete clinical healing. The frequency of complaints was the only independent factor that had an impact on healing; patients with intermittent discharge had a significantly higher rate of complete clinical healing (67%) than those with continuous discharge (40%). There were no notable complications.

Limitations: Short follow-up, small sample size, and no comparisons.

Conclusion: This study demonstrates that the application of silver nitrate solution often produces a favorable outcome in the treatment of anal fistula. This method may be considered as a first-line treatment for the disease because it is simple, performed on an outpatient basis, minimally invasive, and lacks the complications encountered with current conventional surgical modalities.