Quality of life in patients with rectal fistulas

Chronic rectal fistulas have a complex negative impact on patients’ quality of life, comparable to that of severe chronic diseases. In the majority of cases (70–90%), particularly with complex fistulas, there is a significant decline in physical, psycho-emotional, social, and professional well-being. The key factors contributing to this deterioration of the condition include pain, discharge, risk of incontinence, anxiety-depressive disorders, and social maladaptation. For objective assessment, both general scales (SF-36, EQ-5D) and disease-specific questionnaires (FIQL, CAF-QoL, QoLAF-Q) are applied. Treatment outcomes are significantly influenced by the anatomical characteristics of the fistula, functional disorders, and comorbidities such as diabetes mellitus, obesity, and Crohn’s disease. The use of minimally invasive and sphincter-preserving techniques (LIFT, FiLaC, VAAFT) improves quality-of-life indicators by reducing pain, complications, and the risk of incontinence; however, the issues of recurrence and high treatment costs remain unresolved. Quality of life should be regarded as a key criterion for evaluating the effectiveness of surgical treatment of perianal fistulas, while an individualized approach makes it possible to achieve optimal clinical and social outcomes.

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