Moustafa Ahmed, Ebrahim Amr K, Saad Ramy, Mohamed Osama R, Elbarmelgi Mohamed, Balamoun Hany A, Shafik Ismail A
General Surgery, Cairo University, Cairo, EGY.
Surgery, Maidstone and Tunbridge Wells NHS Trust, Maidstone, GBR.
Cureus. 2024 Dec 10;16(12):e75437. doi: 10.7759/cureus.75437. eCollection 2024 Dec.
An anal fistula is a prevalent condition characterised by an abnormal connection between the epithelialised surface of the anal canal and the skin. Surgeons are continually developing new techniques to effectively treat anal fistulae while preserving the patient's continence. This study aims to evaluate the outcomes and complications associated with the management of high perianal fistulae using the fascia lata biological plug (FBP) technique.
This prospective cohort study included all adult patients who presented to the Kasr Al-Ainy Outpatient Surgery Clinic, Cairo, Egypt, between March 2020 and December 2021, with a single-tract high perianal fistula.
A total of 46 eligible patients were included in the study. The insertion of the FBP was associated with complete healing without recurrence in 37 patients (80.4%) at six months post-surgery. Among the 46 patients, only nine (19.6%) experienced fistula recurrence. The recurrence rate increased to 30.4% at 18 months post-surgery, resulting in an overall success rate of 69.6%. Complete continence was maintained in all patients. At 18 months, extra-sphincteric (14.3% vs 0.0%) and supra-sphincteric (21.4% vs 0.0%) types exhibited significantly higher recurrence rates (p=0.006). Anterior fistulae also demonstrated a significantly higher recurrence rate compared to posterior fistulae (64.3% vs 25.0%, p=0.011).
The use of a FBP for the treatment of single-tract high perianal fistulae yields promising results without compromising patients' continence. It is essential to consider the type and nature of the anal fistula when selecting the most appropriate procedure for effective treatment.
肛瘘是一种常见病症，其特征为肛管上皮化表面与皮肤之间存在异常连接。外科医生不断研发新技术，以在保留患者控便能力的同时有效治疗肛瘘。本研究旨在评估使用阔筋膜生物补片（FBP）技术治疗高位肛周肛瘘的疗效及并发症。
这项前瞻性队列研究纳入了2020年3月至2021年12月期间在埃及开罗卡斯尔·艾尼门诊外科诊所就诊的所有成年单通道高位肛周肛瘘患者。
本研究共纳入46例符合条件的患者。术后6个月时，37例患者（80.4%）通过植入FBP实现完全愈合且无复发。46例患者中，仅9例（19.6%）出现肛瘘复发。术后18个月时，复发率增至30.4%，总体成功率为69.6%。所有患者均保持完全控便能力。术后18个月时，括约肌外瘘（14.3%对0.0%）和括约肌上瘘（21.4%对0.0%）的复发率显著更高（p = 0.006）。与后位肛瘘相比，前位肛瘘的复发率也显著更高（64.3%对25.0%，p = 0.011）。
使用FBP治疗单通道高位肛周肛瘘可取得良好效果，且不影响患者的控便能力。在选择最有效的治疗方法时，考虑肛瘘的类型和性质至关重要。
