Fistulotomy and Sphincter Reconstruction in the Treatment of Complex Fistula-in-Ano
| Autor: | Juan Pérez-Legaz, Antonio Arroyo, Pedro Moya, Francisco Pérez-Vicente, Laura Armañanzas, Javier Lacueva, Rafael Calpena, Fernando Candela |
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| Rok vydání: | 2012 |
| Předmět: |
Adult
Male medicine.medical_specialty Manometry Fistula Anal Canal Physical examination Fistulotomy Endosonography Recurrence Pressure medicine Humans Rectal Fistula Fecal incontinence Prospective Studies Prospective cohort study Aged medicine.diagnostic_test business.industry Anorectal manometry Length of Stay Middle Aged medicine.disease Surgery Treatment Outcome medicine.anatomical_structure Sphincter Female medicine.symptom business Grading scale |
| Zdroj: | Annals of Surgery. 255:935-939 |
| ISSN: | 0003-4932 |
| DOI: | 10.1097/sla.0b013e31824e9112 |
| Popis: | OBJECTIVE To evaluate the long-term clinical and manometric results of fistulotomy and sphincter reconstruction for the treatment of complex fistula-in-ano. BACKGROUND Complex fistula-in-ano is difficult to treat due to the occurrence of postoperative anal incontinence and the high rate of recurrence. METHODS Seventy patients who were diagnosed with complex fistula-in-ano and underwent fistulotomy and sphincter reconstruction between October 2000 and October 2006 were analyzed in the present study. Preoperative assessment included physical examination, anorectal manometry, and anal endosonography. Appointments were scheduled every 6 months during the first and second year of treatment and every 2 years thereafter. Recurrence and incontinence were evaluated during each visit. Continence was assessed according to the Wexner continence grading scale. Anal manometry was performed 3 and 12 months after treatment and every 2 years thereafter. Anal endosonography was conducted 6 months after treatment. RESULTS Fistulas were classified as medium-high trans-sphincteric in 64 patients (91.42%) and were recurrent in 22 patients (32%). Before surgery, 22 patients (32%) reported fecal incontinence, which improved after surgery in 15 cases (70%), from 6.75 to 1.88 (P < 0.005) on the Wexner Scale. Eight preoperative continent patients (16.6%) reported postoperative incontinence (Wexner Score < 3), and 6 patients (8.5%) had recurrent incontinence. Among these patients, 2 developed recurrent incontinence 6 months after treatment, 2 developed recurrent incontinence 1 year after treatment, 1 developed recurrent incontinence 2 years after treatment, and 1 developed incontinence 5 years after treatment. CONCLUSIONS Fistulotomy with sphincter reconstruction is an effective technique for the treatment of complex fistula-in-ano. Continence and anal manometry results were improved in incontinent patients and were not jeopardized in continent ones. Fistulotomy with sphincter reconstruction is an especially suitable technique for incontinent patients with recurrent fistulas. |
| Databáze: | OpenAIRE |
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