Complex treatment of anal fistulas with extensive inflammatory infiltration

Background: Anal fistulas with extensive inflammatory infiltration pose significant challenges in treatment, often leading to prolonged hospital stays, complications, and reduced quality of life. This study evaluates the efficacy of rectal suppositories containing streptokinase (15,000 IU) and streptodornase (1,250 IU) as an adjunct to standard therapy, including assessment of inflammatory cytokines.
Methods: A prospective randomized controlled trial was conducted from September 2018 to December 2019 at Weihaiwei People's Hospital. Sixty patients with anal fistulas and extensive inflammatory infiltration were divided into two groups: Group 1 (n=30) received standard treatment per international guidelines, while Group 2 (n=30) received the same plus rectal suppositories. Suppositories were administered based on disease severity: for severe cases, 1 suppository three times daily for 3 days, twice daily for 3 days, and once daily for 3 days; for moderate/mild cases, twice daily for 3 days, then once daily for 4 days or twice daily for 2 days. Outcomes included hospital stay duration, severe disease incidence, complications, pain syndrome (via Visual Analog Scale, VAS), quality of life (QoLAF-Q), and serum levels of TNF-α and IL-1β.
Results: Group 2 showed significantly shorter hospital stays (mean 18.5 ± 4.3 days vs. 12.5 ± 2.9 days, p<0.001), fewer severe cases (37% vs. 13%, p<0.01), fewer complications (27% vs. 10%, p<0.05), lower VAS scores, improved QoLAF-Q scores, and reduced serum TNF-α and IL-1β levels compared to Group 1. Significant positive correlations were observed between TNF-α, IL-1β, VAS, and QoLAF-Q.
Conclusions: Adjunctive enzymatic (streptokinase-streptodornase suppositories) therapy in complex treatment of anal fistulas with extensive inflammatory infiltration demonstrates notable benefits including shortened hospitalization periods, decreased complication rates, reduced pain levels, lowered cytokine concentrations, and enhanced quality of life when compared to conventional treatment alone.