Huang Dandan, Wang Ning, Li Yiping, Ren Donglin, Yang Yong, Wei Kaikai, Li Yanzhu, Liu Zhimin
Department of General Surgery (Coloproctology), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.
Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.
Gastroenterol Rep (Oxf). 2025 Jan 18;13:goaf006. doi: 10.1093/gastro/goaf006. eCollection 2025.
High complex anal fistula is a clinical challenge for proctologists and a nightmare for patients. Although the sphincter-sparing approach seems an ideal surgical intervention, there remains room for improvement in treatment efficacy. Herein, we introduce an enhanced sphincter-sparing approach, namely the fistula occlusion with the internal sphincter flap (FOISF), for treating high complex anal fistulas.
This study evaluated 15 patients with high complex anal fistulas who underwent FOISF between October 2021 and December 2022 in the Sixth Affiliated Hospital, Sun Yat-sen University (Guangzhou, P. R. China). Data on success rates, anal function, and various surgical characteristics were subjected to rigorous analysis.
All patients underwent the FOISF procedure, with a median operation time of 53 min. Fourteen patients achieved primary intention healing, while one patient healed by second intention. No recurrence was observed over a follow-up period of 14-30 months. All patients exhibited satisfactory anal continence, with no statistically significant difference observed between preoperative and postoperative Wexner scores (=0.331). A significant improvement in the quality of life was observed when compared with the preoperative assessment (<0.001).
The preliminary results of the FOISF procedure present an effective approach to treat high complex anal fistula.
高位复杂性肛瘘对直肠科医生来说是一项临床挑战，对患者而言则是一场噩梦。尽管保留括约肌的手术方法似乎是一种理想的手术干预方式，但在治疗效果方面仍有改进空间。在此，我们介绍一种改良的保留括约肌手术方法，即内括约肌皮瓣肛瘘封堵术（FOISF），用于治疗高位复杂性肛瘘。
本研究评估了2021年10月至2022年12月期间在中山大学附属第六医院（中国广州）接受FOISF手术的15例高位复杂性肛瘘患者。对成功率、肛门功能及各种手术特征的数据进行了严格分析。
所有患者均接受了FOISF手术，中位手术时间为53分钟。14例患者一期愈合，1例患者二期愈合。在14至30个月的随访期内未观察到复发。所有患者的肛门节制功能均令人满意，术前和术后韦克斯纳评分之间无统计学显著差异（=0.331）。与术前评估相比，生活质量有显著改善（<0.001）。
FOISF手术的初步结果为治疗高位复杂性肛瘘提供了一种有效的方法。
