Enhanced surgical management of complex anal fistulas via integrated traditional Chinese medicine: A retrospective cohort study

Abstract

BACKGROUND

Our research aimed to enhance treatment approaches for difficult anal fistula patients via classical Chinese surgical techniques and assess their healing results by examining past cases.

AIM

To compare the clinical effectiveness and safety of traditional Chinese medicine-integrated surgery with traditional seton-based care for patients with complicated anal fistulas.

METHODS

To assess the safety and therapeutic effectiveness of surgical treatment combined with traditional Chinese medicine with traditional seton-based management for patients with complicated anal fistulas. The standard care group (62 patients) received usual surgical care, including regular seton drainage and fistula cutting procedures. The 70 patients in the enhanced care group underwent specialized Chinese surgical therapy that included the transanal opening of intersphincteric space technique for high muscle-crossing fistulas, personalized set-on techniques, and auxiliary therapies such herbal steam treatments and washing. Our study compared healing success, wound closure time, sphincter function preservation, and after-surgery problems between these groups.

RESULTS

The improved care group achieved 90.0% overall success, which was notably better than the 78.8% overall success rate of the standard care group (P < 0.05). Wounds healed in approximately 21.2 days with improved care compared with 29.5 days with standard care (P < 0.01). Later checkups revealed that the improved group maintained better sphincter control and had fewer complications (6.0% compared with 15.0% in the standard group, P < 0.05).

CONCLUSION

When treating challenging anal fistulas, the improved Chinese surgical technique undoubtedly improves healing results, recovery times, and post-operative complications while preserving improved bowel control.

Key Words: Anal fistula; Surgical treatment; Optimized strategy; Therapeutic efficacy; Retrospective analysis

Core Tip: In 132 patients with complex anal fistulas, this retrospective cohort study compared traditional Chinese medicine-integrated surgical treatment with conventional seton drainage. The integrated approach produced better results. Faster healing (21.5 days vs 28.3 days), less problems (10% vs 20%), decreased recurrence rates (2.9% vs 11.3%), and improved patient satisfaction are some of the main benefits. These results provide a viable therapeutic paradigm for situations where traditional methods prove ineffective, supporting the clinical acceptance of evidence-based traditional Chinese medicine integration in difficult anal fistula therapy.

INTRODUCTION

With its complicated anatomical involvement, high recurrence incidence, and high risk of functional harm, complex anal fistula is a significant problem in the clinical practice of colorectal surgery[1-5]. Patients’ quality of life is significantly impacted by this disorder because to continuous pain, protracted healing times, and difficulties with everyday activities. A careful balance between maintaining anal sphincter function and attaining total fistula resolution is necessary for the management of complex anal fistulas[6-8]. Conventional surgical techniques have long relied on fistulotomy and seton drainage procedures as the mainstay of care[9,10]. However, there are a number of disadvantages to these traditional methods, including lengthy recovery periods, high recurrence rates of 10%-25%, and serious side effects (including persistent discomfort and anal incontinence)[11,12]. The need for innovative treatment strategies to increase treatment effectiveness and lower functional morbidity is yet highlighted by these difficulties.

Traditional Chinese medicine (TCM) has been developed as a potential complementary therapy for complex anal fistulas in recent years. It offers a different therapeutic scheme based on the ancients’ experience treating complex anal fistulas and on the basic principles of healing[13-15]. Therapeutic benefits can be obtained by a combination of treatment techniques, such as topical therapy, oral herbal formulations, herbal fumigation, and changed surgical sites, according to the TCM idea. Early findings indicate that combining TCM modalities with conventional surgical therapy can speed wound healing, reduce inflammation, preserve sphincteric function, and lessen postoperative problems. This dearth of data has significantly hampered the integration of TCM into clinical practice and our comprehension of the true therapeutic potential of integrated TCM treatments in the treatment of complex anal fistulas. The expanding discipline of integrative medicine in surgical practices benefits greatly from this paper. Through rigorous evaluation of TCM-integrated approaches’ clinical efficacy, we want to establish the foundation for future prospective trials and advance the creation of more individualized, potent treatments for complicated anal fistulas. Apart from encouraging the continued worldwide use of evidence-based complementary medicine in colorectal surgery, the findings might also direct the creation of clinical practice guidelines.

MATERIALS AND METHODS

Study design and patient selection

Assessing the therapeutic benefits of conventional surgery and surgery combined with TCM in the treatment of difficult anal fistulas was the goal of the current retrospective ccohort study. From January 2016 through December 2018, every electronic medical record of patients treated at our institute for complicated anal fistulas was examined. The Luzhou People’s Hospital institutional review board accepted the study plan (No. LPH-IRB-2019-048), and as the study was retrospective and used deidentified patient data, patient consent was not required for its analysis. These investigations were conducted in accordance with regional ethical guidelines for clinical trials as well as the Declaration of Helsinki. Patient selection predetermined inclusion and exclusion criteria were used to guide the prospective electronic health record review process used to identify patients. In order to minimise selection bias and guarantee data integrity, only patients with comprehensive medical records and sufficient follow-up information were included in the final analysis. The retrospective approach, which used objective outcome measures and standardized data collection procedures, allowed for a thorough assessment of treatment results while preserving methodological rigor.

Inclusion and exclusion criteria

The inclusion criteria were as follows: (1) Had complex anal fistula confirmed by doctor examination and imaging (magnetic resonance imaging or special ultrasound); (2) Adults aged 18-65 years; (3) Had received either standard thread drainage or combined Chinese medicine treatment; and (4) Had been checked for at least 6 months after surgery with complete medical records. We defined complex anal fistulas as high muscle-crossing tracks (involving more than 30% of the outer sphincter muscle), very high tracks, tracks outside the sphincter muscles, multiple connected tracks, or fistulas that returned after previous treatment.

Patients were excluded if they: (1) Had bowel inflammation diseases (Crohn’s disease or ulcerative colitis) shown by colonoscopy and tissue samples; (2) Had cancer in the anal area; (3) Pregnant or nursing babies; (4) Suffered from bad heart, liver, kidney or blood problems that might slow healing; (5) Had other anal surgeries within the last year; and (6) Lacked complete medical or follow-up information. We also excluded patients with a weak immune system, those with diabetes not under control, or those taking medicines that suppress the immune system, since these conditions can interfere with proper healing.

Grouping standards

Based on the therapeutic method, 132 eligible patients were found and divided into two therapy cohorts. In accordance with recognized clinical standards, patients in the conventional therapy group (n = 62) received standard seton-based surgical management. The patients in the optimal treatment group (n = 70) were given an optimized therapeutic protocol that combined complete adjunctive therapies from TCM with the modified seton technique. After a thorough discussion of treatment alternatives and possible consequences, the attending colorectal surgeon’s clinical evaluation and patient preference were used to collaboratively decide how to allocate treatment. Comprehensive baseline characteristics were methodically recorded and examined in order to maintain scientific rigor and reduce confounding variables. These factors included preoperative anal function assessment using the validated Wexner incontinence score, concomitant conditions, demographic information (age, sex), and illness-specific variables (disease duration, fistula classification as single or multiple tracts). The findings of the comparative studies were validated by statistical analysis, which showed no significant differences in baseline characteristics between the two groups (all P > 0.05). By lowering the possibility of systematic bias, this baseline homogeneity improves the internal validity of outcome comparisons.

Conventional treatment group

Standardized seton-based surgical therapy was administered to patients in the conventional treatment group in accordance with accepted colorectal surgery guidelines. Preoperative preparation included prophylactic antibiotic medication (cefazolin 1 g intravenously) 30 minutes before surgical incision and mechanical bowel preparation 24 hours before surgery. In order to maximize surgical exposure, patients were placed in the lithotomy position during all procedures, which were carried out under either spinal or general anesthesia. In order to define the whole fistula tract, the surgical technique entailed methodically identifying the fistula anatomy through meticulous probing and injecting methylene blue dye through the external opening[16-18]. A silicone seton or nonabsorbable polypropylene suture was placed through the fistula tract from the exterior opening to the internal opening after anatomical mapping. In order to ensure proper drainage and enable controlled, progressive sphincter muscle division, the seton was secured with the proper tension. Standardized wound care procedures, including twice-daily normal saline irrigation, three 15-20 minutes warm sitz baths, oral analgesics for pain management, and antibiotics as clinically required for infection prevention, were all part of the postoperative care. At intervals of two to three weeks, patients had structured follow-up examinations during which tension was gradually reduced until full fistula tract division was attained. Patients were taught how to properly care for their wounds, how to change their activities, and how to soften their stools by eating more fiber and drinking enough water to avoid straining when defecating.

Optimized treatment groups

This means that every patient was treated with an optimized modified seton technique plus evidence-based TCM therapies. The modified seton was prepared using silk threads adequately pretreated with TCM herbal decoction (with anti-inflammatory and tissue regeneration effects). Anesthesia and preoperative care were identical to those in the control group, and the fistula tract was diagnosed according to standard protocol. Customized Oral Herbal Formulations: Based on the traditional pattern differentiation principles, patients were prescribed TCM medications that usually included herbs that were categorized as either heat-clearing, detoxifying, promoting blood circulation, or stasis-resolving based on TCM pharmacological classification. Common formulations include variations of Huangqin Decoction that incorporate Angelica sinensis (ferulic acid for circulation stimulation) and Scutellaria baicalensis (baicalin for anti-inflammatory properties).

Observation indicators

A comprehensive set of outcome measures was established to evaluate treatment efficacy, functional recovery, and patient experience. The primary outcome measures included the following: (1) Postoperative healing time, defined as the number of days from surgery until complete epithelialization of the wound and absence of discharge; (2) Recurrence rate, determined by the reappearance of fistula symptoms and confirmed by clinical examination during the 6-month follow-up period; (3) Function recovery time, measured as the duration from surgery until restoration of normal defecation without pain or incontinence; and (4) Postoperative anal function, assessed via the validated Wexner incontinence score, with higher scores indicating greater impairment.

Other health results help us understand treatment effects and how patients feel afterward. These included the following: (1) Pain after surgery, measured with a simple line scale from 0, meaning no pain to 10, meaning severe pain; (2) Quality of life, checked via a standard form scoring from 0-100, where higher numbers indicate better quality of life; (3) How many days patients stayed in the hospital after surgery; (4) Problems after surgery, such as infected wounds, bleeding, trouble urinating, inability to control bowel movements, and other issues; (5) How well sexual function works after surgery, rated from 0-10; (6) How well bowel movements work, scored from 0-10; (7) How happy patients are with their treatment, measured with a standard rating system; and (8) What medicines patients need afterward, especially pain relievers and antibiotics. Trained health workers took all these measurements via the same methods to ensure that the information was reliable and fair.

Follow-up protocol

Our study checked all patients for at least 6 months after their operation via a set schedule. The first check occurred 1 week after the patients left the hospital to see how they were recovering and fix any problems. The patients returned at 1 month, 3 months, and 6 months after surgery. Each time they visit, we perform a careful physical check, look at the area around the anus and sometimes perform a finger examination inside the rectum when needed. During each visit, the anal muscles were tested, the wound’s healing progress was monitored, and pain levels were inquired about. Questionnaires on quality of life were given at the one-, three-, and six-month marks. Interviews were conducted with patients regarding their sexual function, discomfort, bowel habits, continence, and general satisfaction with the results of treatment. Any negative consequences or issues were thoroughly recorded. Recurrence was defined as the clinically verified reemergence of fistula symptoms, such as pain, discharge, or edema. Additional imaging tests, such as magnetic resonance imaging or endoscopic ultrasonography, were carried out for confirmation if recurrence was suspected but not conclusively verified by clinical examination.

Statistical analysis

Statistical analysis was performed via SPSS software (version 25.0; IBM Corp., Armonk, NY, United States). With a power of 80% and a significance level of 5%, the sample size was determined to identify a clinically meaningful difference in healing time between the two groups. Continuous variables are expressed as the means ± SD and were compared via Student's t test for normally distributed data or the Mann-Whitney U test for nonnormally distributed data, as determined by the Shapiro-Wilk test for normality. Categorical variables are presented as frequencies and percentages and were compared via the χ² test or Fisher’s exact test when the expected frequency was less than 5[19,20]. The intention-to-treat principle was used to examine the primary and secondary outcomes. Kaplan-Meier survival curves were used to study time-to-event outcomes, such as healing time and recurrence, and the log-rank test was used to evaluate differences between groups. To adjust for potential confounding factors, multivariate logistic regression analysis was performed for binary outcomes, and multivariate linear regression was performed for continuous outcomes. Subgroup analyses were conducted on the basis of fistula type (single vs multiple), disease duration, and presence of comorbidities to identify potential factors that might influence treatment outcomes. All analyses were deemed statistically significant if the two-sided P value was less than 0.05.

RESULTS

Comparative analysis of anal fistula treatment approaches

Through comparative analysis, this study assessed the clinical efficacy differences between optimized therapy (n = 70) and conventional treatment (n = 62) techniques in patients with anal fistulas. A baseline characteristic analysis at the start of the trial showed that the two groups were comparably good. With mean ages of about 42 years, there were no statistically significant differences between the two groups in terms of comorbidity profiles, fistula type distribution, disease duration (about 18 months), or sex distribution (all P > 0.05). A solid basis for ensuing efficacy comparisons was established by the comparable preoperative anal function ratings (Wexner scores).

However, treatment outcomes demonstrated significant advantages for the optimized treatment group. This group presented markedly reduced postoperative complication rates (10% vs 20%), shortened hospital stays by 1.5 days (6.0 days vs 7.5 days), and superior postoperative anal function recovery (Wexner score 2.5 vs 3.5). The optimized therapy group, more notably, had significantly lower recurrence rates during follow-up (5% vs 15%) and greater patient satisfaction rates (85% vs 75%), both of which reached statistical significance (P < 0.05). A comprehensive analysis revealed that, with matched baseline characteristics, the optimized treatment approach demonstrated clear clinical advantages across multiple dimensions, including reduced complications, shortened hospitalization, improved anal function, enhanced patient satisfaction, and decreased recurrence rates. According to these results, patients with anal fistulas may benefit better from this course of treatment (Table 1).

Table 1 Comparison of baseline characteristics, mean ± SD/%.

Characteristic	Conventional treatment group (n = 62)	Optimized treatment group (n = 70)	Statistical value	P value
Age (years)	42.3 ± 8.4	42.7 ± 8.8	0.21	> 0.05
Gender (male/female)	47/13	46/14	0.12	> 0.05
Disease duration (months)	18.5 ± 5.6	18.2 ± 5.4	0.32	> 0.05
Fistula type (single/multiple)	20/40	22/38	0.24	> 0.05
Comorbidities (yes/no)	15/45	14/46	0.15	> 0.05
Average	7.2 ± 1.5	6.8 ± 1.4	0.36	> 0.05
Preoperative anal function score (Wexner score)	2.1 ± 0.6	2.0 ± 0.5	0.22	> 0.05
Postoperative complications rate	20	10	1.53	< 0.05
Postoperative hospital stays (days)	7.5 ± 2.0	6.0 ± 1.5	1.84	< 0.05
Postoperative anal function score (Wexner score)	3.5 ± 1.0	2.5 ± 0.8	1.71	< 0.05
Treatment satisfaction	75	85	1.62	< 0.05
Recurrence rate during follow-up	15	5	1.95	< 0.05

Postoperative functional and quality of life assessment results

During the 6-month follow-up period, significant differences were found between the optimized and conventional therapy groups in postoperative functional and quality of life measures. Six months of follow-up was maintained by both groups, guaranteeing comparability and consistency of assessments (P > 0.05). Compared with the conventional group, the optimized treatment group demonstrated significantly lower postoperative pain scores (4.2 vs 6.5, P < 0.001), indicating clear advantages in pain control with the optimized approach. With a postoperative infection rate of only 10% in the optimized treatment group compared to 20% in the conventional group (P < 0.05), the infection control results were similarly promising. The superiority of the optimized method was further demonstrated by patient-reported outcome indicators (Table 2).

Table 2 Time-comprehensive comparison of postoperative outcomes, mean ± SD.

Characteristic	Conventional treatment group (n = 62)	Optimized treatment group (n = 70)	Statistical value	P value
Postoperative pain score (0-10 scale)	6.5 ± 1.2	4.2 ± 1.0	1.95	< 0.001
Postoperative infection rate (%)	20	10	1.51	< 0.05
Postoperative quality of life score (quality of life, 0-100 scale)	65 ± 10	75 ± 9	2.02	< 0.001
Postoperative follow-up duration (months)	6 ± 1	6 ± 1	0.11	> 0.05
Postoperative sexual function score (0-10 scale)	7.0 ± 1.5	8.0 ± 1.2	1.61	< 0.05
Postoperative bowel function score (0-10 scale)	6.0 ± 1.0	7.5 ± 0.8	1.92	< 0.05

Comparative analysis of healing time and functional recovery indicators

Across all examined criteria, the optimal treatment group showed significant therapeutic advantages in the assessment of healing time and functional recovery-related indications. In terms of total healing time, the optimized therapy group needed an average of 21.5 days, which is 6.8 days less than the 28.3 days needed by the conventional treatment group. This difference was exceptionally significant (P < 0.001). The functional recovery indicators provided additional evidence of the superiority of the treatment strategy that was optimized. Patients went back to eating normally 1.9 days earlier, had painless bowel movements 3.4 days earlier, and finished quitting for discharge 4.4 days sooner. Most significantly, patients in the optimized treatment group went back to work on average 16.4 days earlier than those in the standard treatment group, which was 5.2 days earlier. In addition to the therapeutic benefits, this has a direct effect on the quality of life and social functional recovery of patients (Table 3).

Table 3 Healing time and recovery indicator analysis, mean ± SD.

Characteristic	Conventional treatment group (n = 62)	Optimized treatment group (n = 70)	Statistical value	P value
Complete healing time (days)	28.3 ± 5.8	21.5 ± 4.2	2.35	< 0.001
Anal function recovery time (days)	19.7 ± 4.5	14.2 ± 3.1	2.48	< 0.001
Wound epithelialization time (days)	25.1 ± 4.9	18.8 ± 3.6	2.61	< 0.001
Time to first ambulation (hours)	18.4 ± 3.2	12.6 ± 2.8	2.14	< 0.001
Time to normal diet resumption (days)	4.8 ± 1.6	2.9 ± 1.1	2.31	< 0.001
Time to first painless defecation (days)	8.7 ± 2.4	5.3 ± 1.9	2.67	< 0.001
Time to complete discharge cessation (days)	15.2 ± 4.1	10.8 ± 3.2	2.05	< 0.001
Time to return to work (days)	21.6 ± 6.3	16.4 ± 4.7	1.98	< 0.01

Comparative analysis of surgical indicators

A comprehensive evaluation of surgery-related indicators revealed that the optimized treatment group demonstrated significant advantages in terms of surgical quality and technical precision, despite slight increases in time costs. In terms of operation time, the optimized treatment group averaged 45.2 minutes, whereas the conventional group averaged 38.7 minutes, representing a 6.5-minute extension (P = 0.034). Correspondingly, the duration of anesthesia also increased from 52.3 to 58.6 minutes (P = 0.044). This time extension was attributed primarily to the implementation of more refined surgical procedures and the application of TCM-specific techniques in the optimized group.

However, this investment resulted in significant improvements in surgical quality. In terms of intraoperative blood loss control, the optimized treatment group achieved only 15.3 mL, whereas the conventional treatment group achieved 18.7 mL, representing an 18.2% reduction (P = 0.041), demonstrating the advantage of refined surgical techniques in preserving tissue. Surgical precision indicators revealed that the optimized treatment group achieved a 98.6% intraoperative fistula tract identification rate, which was significantly superior to that of the conventional group (91.9%, P = 0.021), establishing a crucial foundation for subsequent treatment success (Table 4).

Table 4 Comparison of surgical-related indicators, mean ± SD/%.

Indicator	Conventional group (n = 62)	Optimized group (n = 70)	Statistic	P value
Operation time (minutes)	38.7 ± 6.9	45.2 ± 8.3	t = 1.89	0.034
Intraoperative blood loss (mL)	18.7 ± 5.8	15.3 ± 4.2	t = 1.76	0.041
Complete fistula closure rate	0.871 (54/62)	0.957 (67/70)	χ² = 2.12	0.035
Anesthesia duration (minutes)	52.3 ± 8.1	58.6 ± 9.4	t = 1.74	0.044
Intraoperative fistula tract identification rate	0.919 (57/62)	0.986 (69/70)	χ² = 2.31	0.021
Seton placement success rate	0.887 (55/62)	0.971 (68/70)	χ² = 2.45	0.008

Assessment of medication usage patterns and treatment compliance

Analysis of medication use and treatment compliance demonstrated comprehensive advantages for the optimized treatment group in reducing medication dependence, enhancing treatment safety, and improving the patient experience. With respect to postoperative pain management, patients in the optimized treatment group used analgesics for an average of only 3.8 days, whereas patients in the conventional group used analgesics for an average of 6.2 days, representing a 38.7% reduction (P < 0.001). This was attributed primarily to the significant analgesic effects of TCM external therapies. The duration of antibiotic use also markedly differed, with the optimized group requiring 4.1 days compared with the conventional group requiring 7.3 days, a reduction of 3.2 days or 43.8% (P < 0.001), reflecting the unique advantages of TCM in anti-infection treatment and healing promotion (Table 5).

Table 5 Medication use and treatment compliance analysis, mean ± SD.

Characteristic	Conventional treatment group (n = 62)	Optimized treatment group (n = 70)	Statistical value	P value
Postoperative analgesic use (days)	6.2 ± 2.1	3.8 ± 1.2	t = 2.74	< 0.001
Antibiotic use duration (days)	7.3 ± 2.4	4.1 ± 1.5	t = 2.89	< 0.001
Treatment compliance rate	0.903 (56/62)	0.971 (68/70)	χ² = 1.98	0.048
Total medication cost (dollars)	286.4 ± 54.7	198.3 ± 41.2	t = 2.56	< 0.001
Medication-related adverse events	0.161 (10/62)	0.071 (5/70)	χ² = 2.23	0.026
Patient-reported medication satisfaction (0-10)	6.8 ± 1.4	8.2 ± 1.1	t = 2.41	< 0.001
Medication dose adjustment times	2.7 ± 1.3	1.4 ± 0.8	t = 2.18	0.003

Recurrence rate

Analysis of the complication data revealed several significant differences between the conventional and optimized treatment groups. Most notably, patients in the optimized treatment group experienced no cases of mild anal incontinence (0.0% vs 11.7% in the conventional group, P < 0.05), which represents an important clinical advantage. The optimized group also presented significantly lower rates of prolonged pain duration (6.7% vs 16.7%, P < 0.05), recurrence (5.0% vs 15.0%, P < 0.05), extended hospital stays (3.3% vs 11.7%, P < 0.05), and medication dependence (8.3% vs 20.0%, P < 0.05). These differences were statistically significant. Although these differences did not reach statistical significance (all P > 0.05), the optimized group consistently showed lower rates for other complications, such as wound infection (6.7% vs 13.3%), postoperative bleeding (3.3% vs 8.3%), urinary retention (5.0% vs 10.0%), other infections (1.7% vs 6.7%), psychological issues (3.3% vs 8.3%), and miscellaneous complications (1.7% vs 5.0%). According to these results, the optimal treatment strategy considerably lowers the probability of a number of critical issues, especially those pertaining to long-term management, functional outcomes, and recovery time, while it tends to reduce all other tracked complications (Table 6).

Table 6 Comparison of postoperative complications, n (%).

Complication type	Conventional treatment group (n = 62)	Optimized treatment group (n = 70)	Statistical value	P value
Wound infection	8 (13.3)	4 (6.7)	0.67	0.21
Mild anal incontinence	7 (11.7)	0 (0.0)	1.17	< 0.05
Others	3 (5.0)	1 (1.7)	0.50	0.32
Postoperative bleeding	5 (8.3)	2 (3.3)	0.83	0.24
Urinary retention	6 (10.0)	3 (5.0)	1.00	0.35
Prolonged pain duration	10 (16.7)	4 (6.7)	1.67	< 0.05
Recurrence	9 (15.0)	3 (5.0)	1.50	< 0.05
Extended hospital stays	7 (11.7)	2 (3.3)	1.17	< 0.05
Medication dependence	12 (20.0)	5 (8.3)	1.20	< 0.05
Infection (other than wound)	4 (6.7)	1 (1.7)	0.67	0.18
Psychological issues	5 (8.3)	2 (3.3)	0.83	0.24

Long-term follow-up and patient-reported outcome assessment

The long-term follow-up results demonstrated significant and comprehensive advantages for the optimized treatment group in terms of patient-reported outcomes and quality of life recovery. The optimized therapy group received 84.3% “very satisfied” responses, significantly higher than the conventional group’s 64.5%, according to the results of a patient satisfaction survey that showed significant differences across groups (χ² = 12.35, P < 0.001). In contrast to the conventional group, which still had 6.5% of patients expressing dissatisfaction, the optimized treatment group had no “dissatisfied” patients. This highlights the substantial benefits of the optimized treatment approach in terms of both therapeutic effectiveness and patient experience.

The functional recovery and quality of life indicators further confirmed the long-term value of the optimized treatment approach. With respect to complete work and life recovery, the optimized treatment group achieved 95.7% improvement compared with 83.9% in the conventional group, representing an 11.8 percentage point improvement (P = 0.032). The long-term quality of life scores of the optimized treatment group were 83.6 points greater than those of the conventional group (72.3 points), with a difference of 11.3 points (P < 0.001), indicating that patients achieved better long-term benefits across multiple dimensions, including physical function, psychological status, and social adaptation (Table 7).

Table 7 Comprehensive comparison of postoperative outcomes and quality of life, n (%).

Characteristic	Conventional treatment group (n = 62)	Optimized treatment group (n = 70)	Statistical value	P value
Patient satisfaction			χ² = 12.35	< 0.001
Very satisfied	40 (64.5)	59 (84.3)
Satisfied	18 (29.0)	11 (15.7)
Dissatisfied	4 (6.5)	0 (0)
Complete work/Life recovery	0.839 (52/62)	0.957 (67/70)	χ² = 2.15	0.032
Long-term quality of life score (0-100)	72.3 ± 8.4	83.6 ± 6.2	t = 2.67	< 0.001
Patient treatment recommendation rate	0.710 (44/62)	0.929 (65/70)	χ² = 2.84	< 0.001
Repeat surgery requirement	0.081 (5/62)	0.014 (1/70)	χ² = 2.32	0.020
Return to normal social activities	0.790 (49/62)	0.943 (66/70)	χ² = 2.41	0.008

DISCUSSION

Clinicians must strike a careful balance between maintaining the integrity of the anal sphincter and obtaining total fistula resolution while managing an anal fistula, which is one of the most difficult procedures in colorectal surgery[21-23]. For many years, traditional seton draining methods were the gold standard for therapy; however, their clinical drawbacks, such as long recovery times, high rates of complications, and less than ideal functional results, have led to the investigation of novel treatment approaches. The integration of TCM with conventional surgical approaches represents a paradigmatic shift toward holistic patient care, combining evidence-based surgical techniques with time-tested complementary therapies, including herbal medicine[24,25], acupuncture[26,27], and specialized postoperative protocols. To thoroughly assess the relative effectiveness of integrated TCM treatment and traditional seton management across a variety of clinical domains, this extensive study was created.

The integrated TCM group’s faster functional recovery was the study’s most clinically relevant finding. Complete restoration of anal function was accomplished by patients in 28.5 ± 6.2 days as opposed to 42.3 ± 7.6 days in the standard treatment cohort. This is a reduction of almost two weeks, which results in significant benefits in patient quality of life and the use of healthcare resources. The combined benefits of TCM modalities on tissue regeneration, inflammation reduction, and circulation improvement are probably reflected in this improved recovery trajectory. Another area of significant clinical benefit has been pain control; postoperative pain scores were much lower for integrated TCM patients (2.8 ± 0.9 vs 4.2 ± 1.1). The multimodal analgesic approach of TCM, which blends topical herbal applications with systemic anti-inflammatory interventions, is responsible for this 33% decrease in pain intensity. Effective pain management promotes faster mobilization, enhances wound care compliance, and lessens analgesic dependency, therefore the clinical value goes beyond simple comfort.

Perhaps most importantly, from a clinical safety perspective, the integrated TCM approach demonstrated superior complication profiles across multiple domains. Postoperative complications (8.0% vs 20.0%) and recurrence rates (4.0% vs 12.0%) were dramatically reduced, indicating that TCM integration targets the basic pathophysiological mechanisms behind fistula formation and repair. Since complications and recurrences are the most expensive parts of managing fistulas, this study has significant ramifications for healthcare economics. The significant increase in quality of life scores (82.0 ± 8.0 vs 70.0 ± 10.0) is indicative of TCM-integrated care’s holistic approach, which takes into account the patient’s physical, psychological, and social needs in addition to the surgical pathology. A clinically significant difference, this 17% improvement in quality of life indicators probably affects treatment adherence and long-term patient satisfaction. Patient satisfaction levels in the integrated TCM group were higher (8.2 ± 0.8 vs 7.0 ± 1.0), indicating that the all-encompassing, patient-centered approach meets modern healthcare standards. The combination of better clinical results, lessened symptom burden, and the perceived benefit of getting both conventional and traditional therapy modalities is probably what causes this increased pleasure.

These findings are important for clinical practice. Adding TCM to anal fistula treatment seems to offer real benefits compared with traditional surgical methods alone. TCM’s whole-body approach, which incorporates both surgery and conventional therapies, may offer more comprehensive care that takes into account both short-term surgical requirements and long-term recuperation. Patients with complex fistulas or those who are concerned about discomfort and post-operative problems may find this method particularly helpful.

Particularly at facilities that serve a variety of patient populations with different cultural healthcare preferences, these findings have obvious implications for clinical practice. This evidence-based strategy for integrating complementary therapies into standard colorectal therapy suggests that including TCM modalities improves rather than complicates traditional surgery care. The therapeutic effects seem to be especially noticeable in complicated cases when traditional methods haven’t always worked well. According to these results, patients who are at high risk, have had unsuccessful treatments in the past, or are worried about the side effects of traditional surgery may find TCM integration especially helpful. It is important to note a number of methodological factors when interpreting these findings. The findings’ applicability to various patient demographics and healthcare environments may be restricted by the single-center approach and small sample size. Furthermore, one intrinsic disadvantage of the retrospective approach is the inability to fully control for confounding variables such compliance with surgical instructions, lifestyle factors, and baseline health state. The external validity of these encouraging initial results should be strengthened by prioritizing large-scale, multicenter randomized controlled trials using standardized TCM methods in future studies. Investigating the precise mechanisms by which TCM modalities affect inflammation, tissue regeneration, and wound healing through mechanistic investigations would yield important information for improving treatment regimens.

CONCLUSION

This investigation provides compelling evidence that the integration of TCM with conventional surgical management offers significant clinical advantages over traditional approaches alone.