Malakorn Songphol, Sammour Tarik, Khomvilai Supakij, Chowchankit Irin, Gunarasa Shankar, Kanjanasilp Prapon, Thiptanakij Charnjiroj, Rojanasakul Arun
Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Dis Colon Rectum. 2017 Oct;60(10):1065-1070. doi: 10.1097/DCR.0000000000000880.
Ligation of intersphincteric fistula tract is a well-described sphincter-preserving technique for the management of fistula in ano. In 2007, we reported our early experience demonstrating a primary success rate of 94.4%. These findings have since been supported by several short-term studies, but long-term results and secondary cure rates after ligation of intersphincteric fistula tract failure remain unknown.
This study aims to report a 10-year experience of ligation of intersphincteric fistula tract with extended long-term follow-up.
Retrospective analysis of single-center data from May 2006 to October 2010 was performed.
This study was conducted at a large tertiary hospital in Bangkok, Thailand.
All patients with primary or recurrent fistula in ano who underwent a ligation of intersphincteric fistula tract procedure were included. Patients with malignancy, incontinent patients, and patients with rectovaginal fistula were excluded.
Healing as defined by the absence of symptoms with no visible external opening on clinical examination. Follow-up was continued until May 2016.
In total, 251 patients were identified, with a primary healing rate of 87.65% at a median follow-up of 71 months. The healing rates for low transsphincteric, intersphincteric, high transsphincteric, semihorseshoe, and horseshoe fistulas were 92.1%, 85.2%, 60.0%, 89.0%, and 40.0%. Of the 42 patients who had an unhealed fistula after previous non-ligation of intersphincteric fistula tract surgery, 38 (90.48%) healed after the first attempt at ligation of intersphincteric fistula tract. There were 31 patients with unhealed fistulas after the first ligation of intersphincteric fistula tract. Of these, 3 healed spontaneously, and the rest underwent either repeat ligation of intersphincteric fistula tract, fistulotomy (if the recurrence was intersphincteric), or simple curettage (if no internal opening was found). Ultimately, only 2 of the original 251 patients remained unhealed, and there was no change in subjective continence status after surgery.
This study was limited by its retrospective design.
Ligation of intersphincteric fistula tract is an effective technique for the treatment of fistula in ano, including recurrent or unhealed fistula after other procedures. See Video Abstract at http://links.lww.com/DCR/A387.
括约肌间瘘管结扎术是一种已被充分描述的用于治疗肛瘘的保留括约肌技术。2007年，我们报告了早期经验，显示一期成功率为94.4%。此后，这些发现得到了几项短期研究的支持，但括约肌间瘘管结扎术失败后的长期结果和二次治愈率仍不清楚。
本研究旨在报告括约肌间瘘管结扎术10年的经验及长期随访结果。
对2006年5月至2010年10月单中心数据进行回顾性分析。
本研究在泰国曼谷的一家大型三级医院进行。
纳入所有接受括约肌间瘘管结扎术的原发性或复发性肛瘘患者。排除患有恶性肿瘤的患者、大便失禁患者和直肠阴道瘘患者。
以临床检查时无症状且无可见外口来定义愈合。随访持续至2016年5月。
共纳入251例患者，中位随访71个月时一期愈合率为87.65%。低位经括约肌瘘、括约肌间瘘、高位经括约肌瘘、半马蹄形瘘和马蹄形瘘的愈合率分别为92.1%、85.2%、60.0%、89.0%和40.0%。在之前未行括约肌间瘘管结扎术的42例未愈合瘘管患者中，38例（90.48%）在首次尝试括约肌间瘘管结扎术后愈合。首次括约肌间瘘管结扎术后有31例患者瘘管未愈合。其中，3例自发愈合，其余患者接受了括约肌间瘘管重复结扎术、瘘管切开术（如果复发是括约肌间瘘）或单纯刮除术（如果未发现内口）。最终，最初的251例患者中只有2例仍未愈合，术后主观控便状态无变化。
本研究受其回顾性设计的限制。
括约肌间瘘管结扎术是治疗肛瘘的有效技术，包括其他手术治疗后复发或未愈合的肛瘘。见视频摘要：http://links.lww.com/DCR/A387 。
