Original scientific articleFistulotomy with Primary Sphincter Reconstruction in the Management of Complex Fistula-in-Ano: Prospective Study of Clinical and Manometric Results
Section snippets
Methods
We conducted a prospective study of 35 patients undergoing fistulotomy and primary sphincter reconstruction for complex fistula-in-ano, from October 2000 to July 2002 in the Coloproctology Unit, Department of Surgery, University Hospital of Elche. Mean followup was 32±4.8months (range 24 to 42 months). We included fistulas with high trans-sphincteric, suprasphincteric, and extrasphincteric tracks according to Park’s classification for fistula-in-ano.1 Patients suffering from acute anal sepsis
Results
The mean age of the patients was 51.4±9.5 years (range 31 to 73years), 23 were men (65.7%), and 12 women (34.3%). Sixteen patients (45.7%) presented with recurrent fistulas, in 4 of whom (25%) the fistula had recurred twice or more. Seven of the 16 recurrent fistulas (43.8%) had been treated by a cutting seton and 2 (12.5%) with an advancement flap; 4 patients (25%) had their fistula laid-open, all suffering from varying degrees of anal incontinence. The techniques applied in the remaining 3
Discussion
Surgery for complex fistula-in-ano is marked by a high rate of disturbances of anal continence. This may vary from 0% to 25% for flatus control, 0% to 17% for stools, and reach as high as 40% for passive incontinence of any amount (soiling)2 depending on the complexity of the fistula, the presence of associated risk factors for incontinence, and the type of operation. Recurrence is the other great pitfall, oscillating from 0% to 32%. Both have been identified as the factors most markedly
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Competing Interests Declared: None.