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Fistulectomy and sphincteric reconstruction for complex cryptoglandular fistulas
Author(s) -
Roig J. V.,
GarcíaArmengol J.,
Jordán J. C.,
Moro D.,
GarcíaGranero E.,
Alós R.
Publication year - 2010
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/j.1463-1318.2009.02002.x
Subject(s) - medicine , fistulectomy , sphincter , surgery , fistulotomy , fistula , internal anal sphincter , ambulatory , endoanal ultrasound , group b , quality of life (healthcare) , anal fistula , anal canal , rectum , nursing
Objective Complex anal fistulas (CFs) are difficult to treat. Endoanal advancement flap (EAF) is one of the standard treatment options for such clinical conditions. Immediate sphincter repair after fistulectomy (ISR) is not commonly performed because of the fear of causing postoperative incontinence. The objective of this study was to compare the results of both techniques. Method We retrospectively analysed a prospectively entered database composed of 146 patients (112 M; 34 F), undergoing operations for CF of cryptoglandular origin. The patients were divided in two groups: Group A: (EAF); n = 71 patients; Group B: (ISR); n = 75 patients. Results Forty‐two fistulas (28.7%) were recurrent, 98 trans‐sphincteric (TS) and 37 suprasphincteric (SS). Twenty‐six (17.7%) patients had some degree of preoperative continence disturbances, 11 in Group A vs 15 in Group B ( P = 0.47). After a mean follow up of 13 months (12–60), fistula persisted or recurred in 13 (18.3%) patients in Group A vs eight (10.6%) in Group B ( P = 0.19) irrespective of the fistula type (TS or SS). Thirty‐one (43.6%) patients in Group A vs 16 (21.3%) in Group B presented postoperative continence disturbances ( P < 0.001). No changes were observed with the Faecal Incontinence Quality of Life Scale (FIQLS). Group A patients had a significant reduction of maximal rest pressure after surgery. After ISR, no significant changes in pressures were observed. Conclusion Immediate sphincter repair can be a therapeutic option in selected cases of CF, mainly when associated with incontinence or increased risk factors.