General surgery department, Cairo University, Egypt.
General surgery department, Cairo University, Egypt.
Asian J Surg. 2019 Aug;42(8):792-796. doi: 10.1016/j.asjsur.2018.12.005. Epub 2019 Feb 6.
Perianal sepsis and fistula is a troublesome disease in the field of colorectal surgery in term of recurrence and fecal incontinence. The aim of our study is to evaluate the role of 'one stage complex anal fistula excision with reconstruction of anal sphincter without stool diversion' regarding fecal incontinence and recurrence. This was prospective cohort study on 175 patients of complex high peri-anal fistulae, the patients were subjected to fistulectomy and reconstruction (primary suture repair) of anal sphincter without stool diversion, the patients were followed up 1 year postoperatively after complete healing of the wound regarding their continence to stool and gases using Wexner score and recurrence of the fistula which is examined clinically and radio-logically using MRI. Among the 175 patients only four had developed fecal incontinence with varying degrees in which 2 patients developed gas incontinence and 2 patients developed soiling, after 3 months 8 patients had recurrence and after 6-9 months 6 patients developed recurrence . Also at the end of follow up period upon performing the confirmatory MRI, 2 patients showed hidden fistulous tracts ending into a high abscess cavity. This ends up into total of 16 recurrent cases. Five patients experienced delayed wound healing. In conclusion, Compared to other treatment modalities for complex anal fistula found in literature, it had been found that one stage surgery (fistulectomy with primary sphincter repair) has good results regarding healing of the fistula with low risk of incontinence, low recurrence rate and good wound healing.
肛周脓肿和肛瘘是肛肠外科领域中一个令人困扰的疾病，其复发和大便失禁的问题较为突出。本研究旨在评估“不进行粪便转流的一期复杂肛瘘切除与肛门括约肌重建术”在大便失禁和复发方面的作用。这是一项对 175 例复杂高位肛周瘘患者的前瞻性队列研究，患者接受瘘管切除术和肛门括约肌重建（一期缝合修复），不进行粪便转流，在伤口完全愈合后 1 年，通过 Wexner 评分评估患者的粪便和气体失禁情况，通过 MRI 检查评估瘘管的复发情况。在 175 例患者中，仅有 4 例出现不同程度的大便失禁，其中 2 例出现气体失禁，2 例出现粪便污染。术后 3 个月有 8 例复发，术后 6-9 个月有 6 例复发。在随访期末行确认性 MRI 检查时，2 例患者显示隐藏的瘘管终末于高位脓肿腔。总共有 16 例复发。5 例患者出现伤口愈合延迟。总之，与文献中报道的其他治疗复杂肛瘘的方法相比，一期手术（瘘管切除术和一期括约肌修复术）在瘘管愈合方面具有良好的效果，失禁风险低，复发率低，伤口愈合良好。
