Schwandner Thilo, Roblick Michael H, Kierer Walter, Brom Armand, Padberg Winfried, Hirschburger Markus
Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Hospital Giessen, Giessen, Germany.
Dis Colon Rectum. 2009 Sep;52(9):1578-83. doi: 10.1007/DCR.0b013e3181a8fbb7.
This study was designed to analyze the efficacy of the Surgisis Anal Fistula Plug for the closure of transsphincteric anorectal fistulas.
Patients with single transsphincteric anorectal fistulas were prospectively enrolled. Setons were used in all tracts for at least eight weeks before surgery. Continence, surgical variables, complications, and healing rates were recorded. Surgery was performed in a standardized manner. The fistula tract and external opening were debrided, the tract was irrigated, and the plug was placed. The external opening was left open. Success was defined as the absence of drainage and closure of the external opening. Follow-up examinations were performed at 2 days, 2, 4, 6, and 12 weeks, and 6 and 12 months after surgery.
Sixty patients were enrolled. Seventeen patients were smokers, and ten had diabetes mellitus. The mean surgical time was 23 (range, 13-50) minutes; no morbidity occurred. The overall success rate after 12 months was 62%. Nineteen fistulas recurred, and four fistulas never completely healed. The success rate was significantly lower in smokers and diabetics. Two patients had a plug dislodgement, and plugs were successfully replaced. No change in continence was observed.
Because there is still no standard for the treatment of high transsphincteric fistulas and because recurrence rates are high for all procedures performed, new techniques are needed for this complex disease. Our success rate of 62% is promising because this technique can be used as a first approach to close the fistula tract without destruction of the sphincter muscle.
本研究旨在分析Surgisis肛瘘塞治疗经括约肌型肛瘘闭合的疗效。
前瞻性纳入单发性经括约肌型肛瘘患者。所有瘘管在手术前至少使用挂线八周。记录控便情况、手术变量、并发症及愈合率。手术采用标准化方式进行。对瘘管和外口进行清创，冲洗瘘管，置入塞子。外口保持开放。成功定义为无引流且外口闭合。术后2天、2周、4周、6周、12周以及6个月和12个月进行随访检查。
共纳入60例患者。17例患者为吸烟者，10例患有糖尿病。平均手术时间为23（范围13 - 50）分钟；未发生并发症。12个月后的总体成功率为62%。19例瘘管复发，4例瘘管未完全愈合。吸烟者和糖尿病患者的成功率显著较低。2例患者塞子移位，塞子成功更换。未观察到控便情况改变。
由于高位经括约肌型肛瘘的治疗尚无标准，且所有手术方法的复发率都很高，因此对于这种复杂疾病需要新的技术。我们62%的成功率很有前景，因为该技术可作为闭合瘘管的首选方法，而不破坏括约肌。
