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CC BY-NC-ND 4.0 · Journal of Coloproctology 2021; 41(03): 217-221
DOI: 10.1055/s-0041-1735545
Original Article

Evaluation of Fistulotomy with Immediate Sphincteric Reconstruction in the Treatment of High Transsphincteric Perianal Fistula

Yasser A. Orban 
1   Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
,
Hossam Hassan Soliman 
1   Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
,
Ahmed M. El Teliti 
1   Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
,
Ali El-Shewy 
1   Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
,
Yasmine Hany Hegab 
1   Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
,
Amr Ibrahim 
1   Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
› Author Affiliations Funding The authors received no financial support for the research, authorship, and/or publication of this article.
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Abstract

Background High perianal fistula treatment remains challenging, mainly due to the variability in success and recurrence rates as well as continence impairment risks. So far, no procedure can be considered the gold standard for surgical treatment. Yet, strong efforts to identify effective and complication-free surgical options are ongoing. Fistulotomy can be considered the best perianal fistula treatment option, providing a perfect surgical field view, allowing direct access to the source of chronic inflammation. Controversy exists concerning the risk of continence impairment associated with fistulotomy. The present study aimed to assess the outcomes of fistulotomy with immediate sphincteric reconstruction regaring fistula recurrence, incontinence, and patient satisfaction.

Methods This interventional study was performed at the General Surgery Department of Zagazig University Hospital during the period from July 2018 to December 2019 on 24 patients with a clinical diagnosis of high transsphincteric fistula-in-ano. The fistulous tract was laid open over the probe placed in the tract. After the fistula tract had been laid open, the tract was curetted and examined for secondary extensions. Then, suturing muscles to muscles, including the internal and external sphincters, by transverse mattress sutures.

Results Our study showed that 2 patients develop incontinence to flatus ∼ 8.3%.and only one patient develop incontinence to loose stool, 4.2%. Complete healing was achieved in 83% and recurrence was 16.6%.

Conclusion Fistulotomy with immediate sphincteric reconstruction is considered to be an effective option in the management of high perianal fistula, with low morbidity and high healing rate with acceptable continence state.

Keywords

high perianal fistula - anal sphincteroplasty - fecal incontinence


Publication History

Received: 24 October 2020

Accepted: 15 June 2021

Article published online:
20 September 2021

© 2021. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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