Commentary on: Role of Microbiome in the Outcomes Following Surgical Repair of Perianal Fistula: Prospective Cohort Study Design and Preliminary Results

There is little that is more frustrating, let alone depressing, as when a surgeon performs a major complex operation to close a fistula, only to have it return weeks or months later. Fistulae in any site, such as is described in the anal area in the current report, are a vexing problem. Surgeons have long suspected that there is a microbial component to fistulae that continue to recur, yet proof of this claim is no simple matter. Having a fistula recur after a long and complex operation involving its takedown, excision, flap advancement, etc. is not only devastating for the patient who has placed all hope that surgery will finally eliminate the problem, but it can leave the surgeon as second victim when they blame themselves for the unanticipated outcome [1]. While many fistulae connected to the gastrointestinal track spontaneously close with conservative non-operative management, experienced surgeons faced with a chronic non-healing fistula, no matter the location, understand that the results of surgery can be uncertain. …