Association Between Multinucleated Giant Cells and Recurrence of Anal Fistula: A Prospective Cohort Study

Background: Recurrence of anal fistulas represents one of the most frequently encountered complications in fistula management and remains a dilemma. Studies investigating the histological structure of fistulas and their relationship with recurrence are extremely limited. Objective: To evaluate the specimens of anal fistulas for the presence of multinucleated giant cells and to assess whether any correlation existed between giant cell presence and fistula recurrence. Design: Prospective cohort study. Patients: Adult patients with intersphincteric perianal fistulas included. Patients with recurrent fistulas, Crohn’s disease, tuberculosis, malignancy, immunocompromised status, pregnancy, or those who declined surgical intervention were excluded. A total of 62 patients were included in the final analysis. Interventions: Fistulotomy and open biopsy taken from the fistula tract. Main Outcome Measures: Postoperative recurrence rates, presence of multinucleated giant cells in the sampled fistula tracts, and the association between giant cell presence and fistula recurrence. Results: After 6 months of follow-up, healing was achieved in 52 patients (84%), while fistula persistence was observed in 10 patients (16%) and considered as recurrence. Giant cells were significantly higher in the recurrence group, whereas age, gender, ASA score, and comorbidity did not differ significantly between recurrence and non-recurrence groups. Giant cell presence was observed in 3 patients (5.8%) without recurrence compared to 4 patients (40.0%) with recurrence (p = 0.01). Other histological markers showed no significant difference between the groups. Conclusions: Our study demonstrates that giant cell presence represents a significant predictor of recurrence in primary cryptoglandular intersphincteric anal fistula.