De Hous Nicolas, Van den Broeck Thomas, de Gheldere Charles
Department of General Surgery, Heilig-Hartziekenhuis, Lier, Belgium.
Department of Urology, University Hospital of Leuven, Leuven, Belgium.
Acta Chir Belg. 2021 Oct;121(5):308-313. doi: 10.1080/00015458.2020.1753151. Epub 2020 Apr 15.
Fistulotomy remains the gold standard for the surgical treatment of simple anal fistula, but may cause fecal incontinence and a characteristic anal 'keyhole' deformity. Although seemingly trivial, keyhole deformity may lead to bothersome symptoms such as anal pruritus and fecal soiling. This study aims to evaluate the efficacy of fistulectomy and primary sphincteroplasty (FIPS), a technique with immediate sphincter reconstruction, in the treatment of simple anal fistula and the prevention of keyhole deformity created by simple fistulotomy.
A retrospective study was performed on all consecutive patients who underwent FIPS for a simple anal fistula at our institution between January 2015 and August 2019. The primary outcome of the study was the rate of early postoperative wound dehiscence, which essentially transforms a FIPS into a simple fistulotomy and may lead to keyhole deformity. All patients received follow-up at regular intervals to evaluate fistula healing and the presence of keyhole deformity.
FIPS was performed in 24 patients (median age: 52.8 years). After a median follow-up time of 3.0 (2.0, 6.3) months, the overall healing rate was 95.8% (23/24 patients). Six (25%) patients experienced early postoperative wound dehiscence resulting in the development of a keyhole deformity. Five of them were symptomatic (mainly soiling). Keyhole deformity was diagnosed at a median time of 6.0 (3.8, 7.5) months postoperatively. The occurrence of early wound dehiscence and subsequent keyhole deformity was associated with a posteriorly located fistula ( = .02).
FIPS avoids the development of keyhole deformity in the majority of patients with simple anal fistula, but is less successful in posterior fistulas. Since FIPS is a very effective, fast and simple procedure, it should be considered a valid alternative for the treatment of every simple anal fistula.
瘘管切开术仍是单纯性肛瘘外科治疗的金标准，但可能导致大便失禁和典型的肛门“锁孔”畸形。尽管看似微不足道，但锁孔畸形可能会引发诸如肛门瘙痒和粪便污染等令人烦恼的症状。本研究旨在评估瘘管切除术联合一期括约肌成形术（FIPS）这一能立即进行括约肌重建的技术，在治疗单纯性肛瘘及预防单纯瘘管切开术所致锁孔畸形方面的疗效。
对2015年1月至2019年8月期间在本机构接受FIPS治疗单纯性肛瘘的所有连续患者进行回顾性研究。该研究的主要结局是术后早期伤口裂开率，这实际上会将FIPS转变为单纯的瘘管切开术，并可能导致锁孔畸形。所有患者均定期接受随访，以评估瘘管愈合情况及锁孔畸形的存在情况。
24例患者接受了FIPS手术（中位年龄：52.8岁）。中位随访时间为3.0（2.0，6.3）个月后，总体愈合率为95.8%（23/24例患者）。6例（25%）患者术后早期出现伤口裂开，导致锁孔畸形。其中5例有症状（主要为粪便污染）。锁孔畸形在术后中位时间6.0（3.8，7.5）个月时被诊断出来。早期伤口裂开及随后的锁孔畸形的发生与肛瘘位于后方有关（P = 0.02）。
FIPS可避免大多数单纯性肛瘘患者出现锁孔畸形，但对后方肛瘘的效果欠佳。由于FIPS是一种非常有效、快速且简单的手术，应被视为治疗所有单纯性肛瘘的一种有效替代方法。
