Department of Surgery, Erasmus MC, University Medical Center, 's Gravendijkwal 230, Rotterdam, The Netherlands.
Dis Colon Rectum. 2012 Feb;55(2):163-6. doi: 10.1097/DCR.0b013e31823c0f74.
Transanal advancement flap repair is successful in 2 of every 3 patients with a cryptoglandular fistula passing through the middle or upper third of the external anal sphincter. It has been suggested that ongoing disease in the remaining fistula tract contributes to failure. Ligation of the intersphincteric fistula tract might be a useful tool to eradicate this ongoing disease.
The aim of the present study was to evaluate the effect of an additional ligation of the fistula tract on the outcome of transanal advancement flap repair.
This investigation was designed as a prospective clinical study.
The study took place in a university hospital.
A consecutive series of 41 patients with a high transsphincteric fistula of cryptoglandular origin were included.
Ligation of the intersphincteric fistula tract was performed in addition to flap repair.
Early and late complications were recorded. Continence scores were determined with the use of the Fecal Incontinence Severity Index.
Median duration of follow-up was 15 months. Primary healing was observed in 21 patients (51%). Of the 20 patients with a failure, the original transsphincteric fistula persisted in 12 patients. In 8 patients, the transsphincteric fistula was converted into an intersphincteric fistula. These patients underwent subsequent fistulectomy, which was successful in all of them. The overall healing rate was 71%.
This was a preliminary observational study with no control group.
: The ligation of the intersphincteric fistula tract procedure is prone to infection and does not enhance the outcome of flap repair.
经肛门直肠前凸瓣修复术在 2/3 的通过中间或上部外括约肌的隐窝源性肛痿患者中取得成功。有人认为，剩余痿管中的持续性疾病是导致手术失败的原因。结扎括约肌间痿管可能是一种消除这种持续性疾病的有用工具。
本研究旨在评估额外结扎痿管对经肛门直肠前凸瓣修复术疗效的影响。
本研究设计为前瞻性临床研究。
研究在一所大学医院进行。
连续纳入 41 例高位隐窝源性经括约肌肛痿患者。
在瓣修复术的基础上加行括约肌间痿管结扎术。
记录早期和晚期并发症。采用粪便失禁严重程度指数（Fecal Incontinence Severity Index）确定控便评分。
中位随访时间为 15 个月。21 例（51%）患者一期愈合。20 例治疗失败患者中，12 例原经括约肌痿管持续存在，8 例经括约肌痿管转为括约肌间痿管。这 8 例患者随后行痿管切除术，均获得成功。总体愈合率为 71%。
这是一项初步的观察性研究，没有对照组。
括约肌间痿管结扎术容易感染，不能提高瓣修复术的疗效。
