Fistula Excision with Sphincter Repair and/ or Approximation Leaving Long Braided Sutures for Drainage of Intersphencteric Space for Management of Fistula in Ano

Abstract

Background: Fistula-in-ano is the most common form of perineal sepsis. Typically, a fistula includes an internal opening, a track, and an external opening. The external opening might acutely appear following infection and/or an abscess, or more insidiously in a chronic manner. Objective: To analyze the results of surgical excision of intersphencteric, transsphencteric or suprasphencteric perianal fistula by fistula excision with sphincter repair and / or approximation leaving braided sutures for drainage Patients and method: In this prospective study a group consisted of 124 patients with intersphencteric, transsphencteric or suprasphencteric perianal fistulae were treated with fistula excision followed by sphincter repair and / or approximation leaving the ends of the threads long for drainage of intersphencteric space. All patients were observed along one year after surgery for complications, recurrence and / or incontinence Results: The technique was done under spinal anesthesia for 92 patients (74 %) and under general anesthesia for the other 32 patients (26 %). The median operative time was 30 minutes; ranging from 25 to 40 min. there were no postoperative deaths. Hospital stay was less than 24 hrs for all patients. The overall recurrence rate was 4.8 %, with no permanent incontinence. Conclusion: This technique has shown to be highly effective and applicable for management of intersphencteric, transsphencteric or suprasphencteric perianal fistula with low recurrence rate (4.8%), no permanent incontinence and good patient satisfaction.