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

Attaallah, Wafi; Tuney, Davut; Gulluoglu, Bahadir M; Ugurlu, M Umit; Gunal, Omer; Yegen, Cumhur

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.