Lee Kil-Yong, Lee Jumyung, Han Eon Chul, Kwon Yoon-Hye, Ryoo Seung-Bum, Park Kyu Joo
Department of Surgery, The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Uijeongbu, Korea.
Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Ann Surg Treat Res. 2022 Mar;102(3):167-175. doi: 10.4174/astr.2022.102.3.167. Epub 2022 Mar 4.
Cryptoglandular fistula is one of the common anal diseases requiring surgical treatment. Various surgical techniques have been introduced; however, there is no known standard technique. Coring-out fistulectomy is a surgical technique that accurately resects only the fistula tract. However, only a few cases of this procedure have been reported. We aimed to analyze the surgical outcomes of coring-out fistulectomy for cryptoglandular anal fistulas.
We retrospectively reviewed the medical records of patients who underwent coring-out fistulectomy for a cryptoglandular fistula between 1999 and 2019. Primary outcomes were the treatment success rate (recurrence and healing rates) and incidence of fecal incontinence.
A total of 184 patients were included in our study. The average age of the patients was 44 years (range, 16-75 years), and 88.0% were male. Twenty-four (13.0%), 13 (7.1%), and 68 patients (37.0%) underwent operation for recurrent fistula, multiple tracts, and complex type fistula, respectively. The healing rate was 92.4%, and recurrence occurred in 15 of 170 healed patients (8.8%). Thus, the treatment success rate was 84.2%. There was no fecal incontinence except in 1 patient who had preoperative fecal incontinence because of cauda equine syndrome. In multivariable analysis of the factors affecting the treatment success rate, the complex fistula (odds ratio [OR], 14.2; 95% confidence interval [CI], 4.7-43.0; P < 0.001) and undetected internal opening during the operation (OR, 4.0; 95% CI, 1.4-11.6; P = 0.012) were significant factors.
Coring-out fistulectomy is a simple and feasible technique for sphincter-preserving anal fistula surgery.
隐窝腺性肛瘘是需要手术治疗的常见肛门疾病之一。已引入了多种手术技术；然而，尚无已知的标准技术。瘘管剔除切除术是一种仅精确切除瘘管的手术技术。然而，该手术仅报道了少数病例。我们旨在分析隐窝腺性肛瘘瘘管剔除切除术的手术效果。
我们回顾性分析了1999年至2019年间接受隐窝腺性肛瘘瘘管剔除切除术患者的病历。主要结局指标为治疗成功率（复发率和愈合率）及大便失禁发生率。
我们的研究共纳入184例患者。患者的平均年龄为44岁（范围16 - 75岁），男性占88.0%。分别有24例（13.0%）、13例（7.1%）和68例（37.0%）患者因复发性肛瘘、多瘘管和复杂性肛瘘接受手术。愈合率为92.4%，170例愈合患者中有15例复发（8.8%）。因此，治疗成功率为84.2%。除1例因马尾神经综合征术前存在大便失禁的患者外，无大便失禁发生。在影响治疗成功率的多因素分析中，复杂性肛瘘（比值比[OR]，14.2；95%置信区间[CI]，4.7 - 43.0；P < 0.001）和手术中未发现内口（OR，4.0；95% CI，1.4 - 11.6；P = 0.012）是显著因素。
瘘管剔除切除术是一种简单可行的保留括约肌的肛瘘手术技术。
