Treatment Of Transsphincteric Fistulas Research Articles

Outcome of Core out Fistulectomy with Anal Spincter Reconstruction and Primary Repair of Internal Opening in the Treatment of Complex Anal Fistula; A Experience of 30 Cases

Background: The principal of management of anal fistula include closure of interior opening of fistula tract, drainage of contamination or necrotic tissue, and eradication of fistulous tract with maintenance of sphincter function. The selection of surgical operation (simple fistulotomy, fistulectomy, seton placement, development flap, fibrin glue or anal plug) is decided with the aid of the route of the fistula tracts and continence status. Objectives: The aim of the study was to determine the surgical technique “core out fistulectomy with anal sphincter reconstruction and primary closure of internal opening” in the treatment of trans-sphincteric fistula (high type or long tract) or supra-sphincteric fistula in terms of fistula healing, morbidity, recurrence and anal continence. Methods: This prospective observational study was carried out in the Department of Surgery Dr Amanat khan hospital and other private hospitals, Dhaka, Bangladesh, during 5th March 2020 to 10th April 2022. A total 30 patients between the age group 20 to 70 years who were diagnosed with Fistula-in-Ano(Complex Variety) which underwent Core out Fistulectomy with Anal Spincter Reconstruction and Primary Repair of Internal Opening. This analysis was done using SPSS 24 software version. The level of significance was set to 5% (p < 0.05). Results: There were 30 (91%) men and three (9%) women with a median age of 42 years. The common anal fistula type was high transsphincteric fistula in 31 patients with deep postanal abscess in two patients and two patients were suprasphincteric fistula. Conclusions: Core out fistulectomy with anal sphincter reconstruction and major closure of inner opening is a secure and nice method for excessive trans-sphincteric fistula. It has desirable useful results and no disturbance of continence. This has to be viewed in the cure of high trans-sphincteric fistula.

Ligation of intersphincteric fistula tract versus fistulectomy in transsphincteric perianal fistula: a randomized, clinical trial

Background Management of transsphincteric perianal fistula is mainly surgical; fistulectomy, fistulotomy, or ligation of intersphincteric fistula tract LIFT technique shows diversity in their outcome. Continence status is considered the most important point in the treatment outcome followed by recurrence rate and local wound complications. The emerged LIFT technique was claimed for a better outcome.. In this study, our aim is to compare between LIFT technique and fistulectomy in transsphincteric perianal fistulas. Patients and methods In all, 78 patients with transsphincteric perianal fistula were randomly allocated into group A: 39 patients who underwent LIFT and group B 39 patients who underwent fistulectomy. The patient follow-up and operative data were recorded and properly analyzed. Results The preoperative and demographic data between both groups show nonsignificant differences. Operative time was significantly shorter in the fistulectomy group. In the LIFT group recurrence and nonhealing of fistula were significantly higher (six cases) versus one in the fistulectomy group. Incontinence is significantly higher in the fistulectomy group (four cases) and zero in the LIFT group. Wound infection and dehiscence were more in the LIFT group. Conclusion In the treatment of transsphincteric fistula, LIFT technique led up to a lower incontinence rate than fistulectomy, but fistulectomy has proved to have a lower recurrence rate.

CAN Stryphnodendron adstringens EXTRACT IMPROVE THE RESULTS OF FISTULOTOMY FOLLOWED BY PRIMARY SPHINCTEROPLASTY IN THE TREATMENT OF TRANSSPHINCTERIC FISTULAE?

ABSTRACT Background: There is still a need for progress in the treatment of transsphincteric anal fistulae and the use of herbal medicines seems promising. Aim: To evaluate the efficacy of Stryphnodendron adstringens associated with fistulotomy and primary sphincteroplasty in the treatment of transsphincteric fistulae in rats. Methods: Thirty Wistar rats were used, which were submitted to transsphincteric fistulas with steel wire 0; after 30 days a treatment was performed according to the group. Group A (n=10) was submitted to fistulotomy; group B (n=10), fistulotomy followed by primary sphincteroplasty with “U” stitch with polyglactin 911 4-0; group C(n=10) , similar to group B, but with the interposition between the muscular stumps of hemostatic sponge soaked in Stryphnodendron adstringens extract. Euthanasia was performed after 14 days, resecting a segment of the anal canal for histological analysis, which aimed to evaluate the closure of the fistula, the area of separation of the muscle cables, the inflammatory process and the degree of fibrosis. Results: No animal had a remaining fistulous tract. About the spacing between the muscle cables, an average of 106.3 µm2 was observed in group A, 82.8 µm2 in group B and 51.8 µm2 in group C (p<0.05). There was no difference between the groups regarding the inflammatory process and, in relation to fibrosis, in group A there was a mean of 0.6, in group B 0.7 and in group C 0.2 (p<0.05). Conclusions: Stryphnodendron adstringens extract was able to allow less spacing between muscle cables in rats submitted to fistulotomy followed by primary sphincteroplasty, in addition to providing less local fibrosis.

Fistulectomy with primary sphincter reconstruction in the treatment of high transsphincteric anal fistulas

The treatment of transsphincteric anal fistulas is a challenge between recurrence rate and incontinence. Many surgical and conservative procedures have been described in the treatment of anal fistulas. Fistulectomy and primary sphincter reconstruction (FPSR) has not gained great popularity in this field due to the risk of sphincter damage. The aim of this study is to evaluate FPSR in the treatment of transsphincteric fistulas. We retrospectively analyzed 50 patients with high transsphincteric fistulas of cryptoglandular origin that were treated with FPSR between 2005 and 2008. Preoperative assessment included physical and proctologic examination. Continence and pain scores were evaluated preoperatively and postoperatively. In our 50 patients, 22 patients (44%) had a previous proctologic operation and 11 patients (22%) presented with recurrent fistulas. The fistulas existed for an average of 8months. The operation time was 28 ± 16min. Mean follow-up was 22± months. The fistula healed in 44 patients (88%) who developed no recurrence. In five patients (10%), the fistula healed, but they developed a recurrence in the observation period. In one patient (2%), the fistula did not heal. Three patients developed low-grade incontinence for flatus, and one patient with 2° incontinence improved. Preoperatively and postoperatively calculated continence and pain scores showed a slight but significant elevation in the Clinical Continence Score, the German Society of Coloproctology Score showed no significant difference, and preexisting pain was reduced significantly by surgery. FPSR is a safe surgical procedure for the treatment of high transsphincteric anal fistula. The primary healing rate is high with a low risk of recurrence or incontinence.

Can More than One Fistula Be Treated by a New Type of Seton Concomitantly?

Objective: The treatment of trans-sphincteric fistulas is a surgical challenge since eradicating the fistula tract while maintaining the anal continence is vitally important. In this study we documented the outcomes of the patients with one or more fistulas treated at the same operation with a new type of seton. Patients and Methods: The study included 78 patients with 107 high anal fistulas who were treated with seton between 2007 and 2011. Fifty seven patients had only one fistula, 13 patients had two isolated fistulas and 8 patients had three isolated fistulas. Group I was the patients with one fistula and Group II was the patients having more than one fistula. Postoperative complications, hospital stay, cutting through the sphincter and healing times and Wexner’s scores were compared between the two groups. Results: In Group I, there were 57 patients and in Group II, 21 patients were operated for 50 fistulas. No postoperative complications were observed except urinary retentions (4 patients in Group I, 3 patients in Group II). No infection on the operation site was documented in both groups, in Group I none of the patients needed extra dose of narcotic analgesic but in Group II two of the patients who had 3 fistulas were discharged on the second postoperative day because of pain on the operation site. The median for the cutting seton to cut through the sphincter was 31 days and complete healing was achieved with a median of 40 days in Group I, whereas it was 56 and 65 days respectively for Group II. There were no recurrences in our patients in both groups. Although the Wexner scores of the both groups were low, the difference between the groups was statistically significant. Conclusion: It seems to be feasible to perform seton by using a cheap, effective, easily inserted material, also in treatment of patients with more than one fistula while preserving anal continence.

Treatment of trans-sphincteric fistulae by full thickness anorectal advancement flaps

Treatment of trans-sphincteric fistulae by full thickness anorectal advancement flaps

Controlled, randomized trial of island flap anoplasty for treatment of trans–sphincteric fistula–in-ano: early results

Treatment of trans-sphincteric fistula is usually a compromise between recurrence and incontinence. Dermal island flap anoplasty has been found to be useful in the treatment of these fistulas. We performed a randomized trial to compare dermal island flap anoplasty with conventional treatment for trans-sphincteric fistula-in-ano. Seventy nine patients with fistula-in-ano were recruited; twenty patients with trans-sphincteric fistula confirmed by endoanal ultrasound were prospectively randomized to receive either dermal island flap anoplasty (IFA) or conventional treatment (CVN) for trans-sphincteric fistula-inano. Conventional treatment consisted of lay open fistulotomy or seton insertion if deemed unsuitable for fistulotomy. Dermal island flap anoplasty involved a cutaneous advancement flap into the rectum. Pain scores, fecal incontinence scores, operative complications, wound healing and recurrence rates were charted. Two patients in the CVN group required seton insertions, which were still intact at the 9-month follow-up. Two patients with similar high trans-sphincteric fistula in the IFA group avoided having a long-term seton. There were no differences in the postoperative pain score, incontinence score, complications, wound healing and recurrence rates between the two groups. IFA is a safe and useful method for treating transsphincteric fistula. It can be considered when a suprasphincteric extension is suspected, thus avoiding risk of incontinence or the discomfort of a long-term seton.

Long-term results and quality-of-life outcomes in patients with transsphincteric fistulas after muscle-filling procedure.

This study was designed to evaluate long-term results and quality-of-life outcomes after the muscle-filling procedure for posterior transsphincteric fistulas. A questionnaire was mailed to 207 patients who had been treated by the muscle-filling procedure for posterior transsphincteric fistulas with cryptoglandular origin at the Social Health Insurance Hospital during a ten-year period. One hundred fifty-one patients who returned their questionnaires were included in this retrospective study. Information regarding fistula recurrence, time required for wound healing, postoperative incontinence, overall satisfaction with the procedure, and quality-of-life data were surveyed from the returned questionnaires. One hundred fifty-one patients (140 males) with a mean age of 48 (range, 17-75) years were analyzed. The mean follow-up was 70 (range, 12-131) months. Fistulas recurred in seven patients (4.6 percent). Fifty-eight patients (38 percent) healed within 3 months, and 52 (34 percent) healed within 6 months. Eighty-four patients (56 percent) reported some reduction in their sense of sphincter-tightening ability after surgery. Seventy-eight patients (52 percent) reported some degree of incontinence. One hundred thirty-three patients (88 percent) were satisfied or very satisfied with their outcomes. Of the 18 patients (12 percent) who reported unsatisfactory or very unsatisfactory results, 7 experienced recurrence. Thirty-seven patients (25 percent) indicated one or more lifestyle alterations, including social activities (11 percent), travel (12 percent), sports (5 percent), diet (4 percent), housework (1 percent), or sexual activities (1 percent), because of incontinence after surgery. Eighteen patients (12 percent) had more than one restriction in their quality-of-life parameters. The muscle-filling procedure is a viable option in the treatment of transsphincteric fistulas, with a favorable recurrence rate and an overall patient satisfaction rate above 88 percent.