Eray İsmail Cem, Yavuz Burak, Aydin Ishak, Gumus Serdar, Topal Ugur, Dalci Kubilay
Department of General Surgery, Çukurova University Faculty of Medicine, Adana 01130, Türkiye.
World J Gastrointest Surg. 2025 Jun 27;17(6):106531. doi: 10.4240/wjgs.v17.i6.106531.
Both the etiology and treatment of perianal fistulas present challenges, and there is no standard surgical approach.
To present the results of a modified fistulotomy technique that was implemented in a tertiary coloproctology reference center.
Seventy-two patients who underwent surgical intervention for perianal fistula between August 2019 and January 2023 were treated using a modified fistulotomy technique. In this approach, the fistula tract was excised from the external opening up to the external sphincter fibers. The internal orifice was widened, and the septic focus within the inter sphincteric space was curetted. Partial internal sphincterotomy was performed up to the inter sphincteric plane. The anoderm from the internal orifice to the inter sphincteric space was closed with absorbable suture material, and a loose seton was placed at the level of the external sphincter.
The 72 patients who underwent modified fistulotomy were 77.8% male and 22.2% female, with a mean age of 42.2 ± 11.5 years. The median follow-up period was 19 months. Preoperatively, 93.1% of patients had high trans sphincteric fistulas, and 6.9% were females with anterior low trans sphincteric fistulas. In all cases, setons were placed during surgery using vascular tape. A total of 12.5% of patients experienced incontinence, involving gas (6.9%) or soiling (5.6%). There were no reports of solid or liquid incontinences. Complete healing was achieved in 83.3% of the patients, with a recurrence rate of 4.2% and a non-healing rate of 12.5%.
Our preliminary analysis suggests that this modified fistulotomy technique that targets distalization of the internal orifice is a promising alternative management strategy for perianal fistulas.
肛周瘘管的病因和治疗均存在挑战，且尚无标准的手术方法。
介绍在一家三级结直肠病参考中心实施的改良肛瘘切开术技术的结果。
2019年8月至2023年1月期间接受肛周瘘管手术干预的72例患者采用改良肛瘘切开术技术进行治疗。在该方法中，从外口至外括约肌纤维切除瘘管。扩大内口，并刮除括约肌间间隙内的感染灶。在括约肌间平面进行部分内括约肌切开术。用可吸收缝合材料封闭从内口至括约肌间间隙的肛管皮肤，并在肛门外括约肌水平放置一根宽松的挂线。
接受改良肛瘘切开术的72例患者中，男性占77.8%，女性占22.2%，平均年龄为42.2±11.5岁。中位随访期为19个月。术前，93.1%的患者患有高位经括约肌瘘管，6.9%为患有低位前侧经括约肌瘘管的女性。在所有病例中，手术期间均使用血管带放置挂线。共有12.5%的患者出现失禁，包括排气失禁（6.9%）或污粪失禁（5.6%）。未报告固体或液体失禁情况。83.3%的患者实现完全愈合，复发率为4.2%，未愈合率为12.5%。
我们的初步分析表明，这种以内口远移为目标的改良肛瘘切开术技术是一种有前景的肛周瘘管替代治疗策略。
