Abstract
BackgroundSurgical management of complex perianal fistula associated with pararectal cavities can be challenging. We hypothesised that healing of the pararectal cavities prior to healing of the fistula leads to a better outcome. We aimed to assess the efficacy of irrigation catheters in the healing of pararectal cavities associated with fistula-in-ano.MethodsThis study design was consistent with IDEAL stage 2a (development) and was conducted at the Professorial Surgical Unit, National Hospital of Sri Lanka, Colombo. Thirty-two patients with complex fistulae with a pararectal cavity (detected by 2D-Endoanal ultrasounography-EAUS) were included. All patients underwent examination under anaesthesia (EUA), during which insertion of an irrigation catheter to the pararectal cavity and tagging of the primary fistula tract with a drainage seton was done. Patients were advised to irrigate with antiseptic solution and were followed-up at three weekly intervals to assess cavity reduction.ResultsThe majority were males (96.8%, n = 31). The primary fistula tract in 26 patients (81.2%) was trans-sphincteric and was inter-sphincteric in 6 patients (18.7%). Mean time of cavity contraction was 34.78 (range, 21–112) days. Complete healing was seen in 87.5% (n = 28), with 3 patients (9.37%) being lost to follow-up and 1 patient (3.12%) having a persistent perianal fistula after 6 months of follow-up. Those who had complete healing were followed up for a median duration of 6 (range, 3–20) months and there were no recurrences.ConclusionsIrrigation in the management of pararectal cavities yielded satisfactory results. A case control trial with larger numbers and assessment of cavity size pre and post procedure by 3D-EAUS/MRI evaluation would be necessary for more objective evaluation of the efficacy of this novel intervention.
Highlights
Surgical management of complex perianal fistula associated with pararectal cavities can be challenging
Sepsis spreads in the inter-sphincteric plane and sometimes extends into other tracts as described by Parks, forming inter-sphincteric, trans-sphincteric, extra-sphincteric and supra-sphincteric fistula tracts [2]
We focused on pararectal cavities which contain necrotic material
Summary
Surgical management of complex perianal fistula associated with pararectal cavities can be challenging. We hypothesised that healing of the pararectal cavities prior to healing of the fistula leads to a better outcome. We aimed to assess the efficacy of irrigation catheters in the healing of pararectal cavities associated with fistula-in-ano. Fistula-in-ano is a frequently encountered problems in surgical practice. Perianal fistula usually have a criptoglandular aetiology and develop from perianal gland infection. Sepsis spreads in the inter-sphincteric plane and sometimes extends into other tracts as described by Parks, forming inter-sphincteric, trans-sphincteric, extra-sphincteric and supra-sphincteric fistula tracts [2]. In addition to the primary fistula tract, there may be associated blind extensions or para rectal cavities which are extensions of the fistula tract [6]. We focused on pararectal cavities which contain necrotic material. Treatment of para rectal cavities may be difficult as debridement of necrotic material in para rectal cavities cause large perineal wounds
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