Integrating traditional Chinese medicine in anal fistula surgery: A step forward in holistic patient care

Abstract

This letter comments on the retrospective cohort study by Liu et al, which evaluates the integration of traditional Chinese medicine (TCM) with conventional seton-based surgery for complex anal fistulas. The study reports a 90.0% success rate in the TCM-integrated group vs 78.8% in the conventional group, with a mean healing time reduced from 28.3 days to 21.5 days and recurrence rates of 5.0% vs 15.0%. These outcomes highlight the potential of TCM modalities - such as herbal decoctions and fumigation - to complement surgical management by addressing inflammation, pain, and tissue regeneration. While the retrospective design and single-center setting warrant cautious interpretation, this work provides a valuable foundation for future randomized trials and underscores the importance of personalized, integrative approaches in colorectal surgery. Further research should focus on standardizing TCM protocols and elucidating the underlying mechanisms of its efficacy.

Key Words: Anal fistula; Traditional Chinese medicine; Holistic care; Integrative medicine; Surgical outcomes; Personalized medicine

Core Tip: This commentary discusses the study by Liu et al, which provides evidence for integrating traditional Chinese medicine with surgery in complex anal fistula management. We emphasize how this approach aligns with holistic care principles, addressing both anatomical defects and underlying inflammatory and regenerative processes. While the study’s retrospective design limits causal inference, it highlights the potential of integrative strategies to improve clinical outcomes and patient satisfaction, paving the way for future randomized trials to standardize protocols and validate efficacy.

TO THE EDITOR

We read with interest the retrospective cohort study by Liu et al[1] entitled “Enhanced surgical management of complex anal fistulas via integrated traditional Chinese medicine”. The authors present a compelling integration of traditional Chinese medicine (TCM) with conventional seton-based surgery, reporting a 90.0% overall success rate in the TCM-integrated group compared to 78.8% in the conventional group, along with a reduction in mean healing time from 28.3 days to 21.5 days and recurrence rates of 5.0% vs 15.0%. These results suggest that TCM modalities - such as herbal decoctions and fumigation - may complement surgical management by targeting postoperative challenges including inflammation, pain, and tissue regeneration[1]. The strength of this integrative approach lies in its alignment with holistic care principles. While conventional surgery corrects anatomical defects, adjunctive TCM therapies may foster a more favorable healing microenvironment. For instance, herbal components such as baicalin from Scutellaria baicalensis and ferulic acid from Angelica sinensis have demonstrated anti-inflammatory and circulation-promoting properties in preclinical studies[1,2]. Moreover, other commonly used TCM herbs - such as Coptis chinensis, Lonicera japonica, and Taraxacum mongolicum - exhibit broad-spectrum anti-inflammatory and antimicrobial effects, which may contribute to reduced postoperative infection and enhanced wound healing[2]. This multimodal strategy addresses both the structural and pathophysiological aspects of fistula recovery. However, the retrospective design and single-center nature of the study limit the generalizability of the findings. The absence of randomization and blinding may introduce selection bias and unmeasured confounding, which could influence outcomes such as healing time and patient satisfaction. Future research should prioritize multicenter, randomized controlled trials with standardized TCM protocols to enhance reproducibility and validate these preliminary results. Furthermore, the integration of TCM into conventional surgical practice presents several challenges. These include the need for standardized TCM formulations, effective collaboration models between surgeons and TCM practitioners, and considerations regarding cost-effectiveness and insurance coverage. Addressing these issues are essential for the widespread adoption and sustainable implementation of integrative care models. In conclusion, Liu et al[1] provide a valuable foundation for integrative management in proctology. Their work underscores the potential of combined surgical and traditional medicine approaches to improve outcomes in complex anal fistula treatment. We support the call for further rigorous research to translate this evidence-based, holistic paradigm into clinical practice.