Garg Pankaj, Garg Mahak
Pankaj Garg, Mahak Garg, Indus Super Specialty Hospital, Haryana 134113, India.
World J Gastroenterol. 2015 Apr 7;21(13):4020-9. doi: 10.3748/wjg.v21.i13.4020.
To check the efficacy of the PERFACT procedure in highly complex fistula-in-ano.
The PERFACT procedure (proximal superficial cauterization, emptying regularly fistula tracts and curettage of tracts) entails two steps: superficial cauterization of mucosa at and around the internal opening and keeping all the tracts clean. The principle is to permanently close the internal opening by granulation tissue. This is achieved by superficial electrocauterization at and around the internal opening and subsequently allowing the wound to heal by secondary intention. Along with this, all the tracts are curetted and it is ensured that they remain empty and clean in the postoperative period until they heal completely. The latter step also facilitates the closure of the internal opening by preventing collected fluid in the tracts from entering the internal opening and thus not letting it close. Objective incontinence scoring was done preoperatively and 3 mo after the operation.
Fifty-one patients with complex fistula-in-ano were prospectively enrolled. The median follow-up was 9 mo (5-14 mo). The mean age was 42.7 ± 11.3 years. Male:female ratio was 43:8. Fistula was recurrent in 76.5% (39/51), horseshoe in 50.1% (26/51), had multiple tracts in 52.9% (27/51), had an associated abscess in 41.2% (21/51), was anterior in 33.3% (17/51), the internal opening was not found in 15.7% (8/51) and 9.8% (5/51) of fistulas had a supralevator extension. Seven patients were excluded (5 lost to follow up, 2 with tuberculosis leading to/associated with fistula-in-ano). The success rate was 79.5% (35/44) and the recurrence rate was 20.5% (9/44). Out of these recurrences, three underwent reoperation (2 PERFACT procedure, 1 fistulotomy) and all three were successful. Thus, the overall success rate was 86.4%. The only complication was a non-healing tract in 9.1% (4/44) of patients. There was no significant change in objective incontinence scores three months after the operation. The pain was minimal, with all patients resuming their normal activities within 72 h of the operation.
The PERFACT procedure is a new effective method for complex fistula-in-ano, effective even in fistula associated with abscess, supralevator fistula-in-ano and where the internal opening is non-localizable.
检验PERFACT手术治疗高度复杂肛瘘的疗效。
PERFACT手术（近端浅表烧灼、定期清空瘘管并刮除瘘管）包括两个步骤：对内口及其周围的黏膜进行浅表烧灼并保持所有瘘管清洁。其原理是通过肉芽组织永久性闭合内口。这通过对内口及其周围进行浅表电灼，随后让伤口二期愈合来实现。与此同时，刮除所有瘘管，并确保在术后直至完全愈合期间瘘管保持空虚和清洁。后一步骤还通过防止瘘管内积聚的液体进入内口，从而避免内口闭合，促进内口的闭合。术前及术后3个月进行客观失禁评分。
前瞻性纳入51例复杂性肛瘘患者。中位随访时间为9个月（5 - 14个月）。平均年龄为42.7±11.3岁。男女比例为43:8。76.5%（39/51）的肛瘘为复发性，50.1%（26/51）为马蹄形，52.9%（27/51）有多个瘘管，41.2%（21/51）伴有脓肿，33.3%（17/51）位于前方，15.7%（8/51）未找到内口，9.8%（5/51）的肛瘘有提肌上扩展。7例患者被排除（5例失访，2例因结核病导致/伴发肛瘘）。成功率为79.5%（35/44），复发率为20.5%（9/44）。在这些复发病例中，3例接受了再次手术（2例PERFACT手术，1例肛瘘切开术），且全部成功。因此，总体成功率为86.4%。唯一的并发症是9.1%（4/44）的患者存在未愈合的瘘管。术后3个月客观失禁评分无显著变化。疼痛轻微，所有患者在术后72小时内恢复正常活动。
PERFACT手术是治疗复杂性肛瘘的一种新的有效方法，即使对于伴有脓肿、提肌上肛瘘以及内口无法定位的肛瘘也有效。
