Ergüder Ender, Osmanov İgbal, Leventoglu Sezai, Ahmadov Javid, Kösehan Dilek, Mentes Bülent
Department of Surgery, Ankara Etlik City Hospital, Ankara, Türkiye.
Proctology Unit, Ankara Memorial Hospital, Ankara, Türkiye.
BMC Surg. 2025 Jul 3;25(1):252. doi: 10.1186/s12893-025-02840-w.
This study aimed to investigate the specific entity of long fistulas through an analysis of our own cases. Cryptoglandular anal fistulas exceeding 7.5 cm (about 3 inches) in length were carefully documented preoperatively, intraoperatively, and postoperatively in order to provide any possible contribution to our current understanding and treatment of this extraordinary type of fistula.
Patients who were operated on for long fistula, between January 2022 and November 2023, were investigated retrospectively with previously designed forms. Demographic data, clinical history and data, magnetic resonance imaging findings, operation notes, and detailed intraoperative photographs were recorded, as were the postoperative course and complications.
Of the 241 anal fistula patients operated on by our proctology team, 19 (7.9%) had fistulas exceeding 7.5 cm in length, and 14 fulfilled the inclusion criteria. Moreover, 11 (79%) had anterior anal fistulas and three had posterior anal fistulas, all exceeding 7.5 cm. The fistulas of five (35.7%) patients were intersphincteric, and those of nine patients were low transsphincteric. None of the 11 long anterior fistulas conformed to Goodsall's rule. For these patients, their time off work was generally long, especially for those with jobs such as truck driving. A single recurrence was noted within the duration of the study, but it was not a long fistula.
Goodsall's rule, which states that anterior fistulas exceeding 3 cm in length originate posteriorly, might not hold true for long anterior fistulas. Only transsphicteric fistulas may form new fistula tracts within the ischiorectal fossa, resulting in multiple external orifices, while still not conforming to this rule. However, these long fistulas can actually be classified as simple fistulas, originating from the cryptoglandular intersphincteric region or passing through only part of the external sphincter. The only concerns to consider are prolonged wound care and time off work.
本研究旨在通过对我们自己的病例进行分析，调查长瘘管的具体情况。对长度超过7.5厘米（约3英寸）的隐窝腺性肛瘘在术前、术中和术后进行仔细记录，以便为我们目前对这种特殊类型瘘管的理解和治疗提供任何可能的帮助。
对2022年1月至2023年11月期间因长瘘管接受手术的患者，使用预先设计的表格进行回顾性调查。记录人口统计学数据、临床病史和数据、磁共振成像结果、手术记录以及详细的术中照片，还有术后病程和并发症。
在我们直肠外科团队手术的241例肛瘘患者中，19例（7.9%）瘘管长度超过7.5厘米，14例符合纳入标准。此外，11例（79%）为前位肛瘘，3例为后位肛瘘，均超过7.5厘米。5例（35.7%）患者的瘘管为括约肌间型，9例患者的瘘管为低位经括约肌型。11例长前位瘘管均不符合古德索尔法则。对于这些患者，他们的误工时间通常较长，尤其是从事卡车驾驶等工作的患者。在研究期间记录到1例复发，但不是长瘘管。
古德索尔法则指出，长度超过3厘米的前位肛瘘起源于后方，对于长前位肛瘘可能并不适用。只有经括约肌瘘管可能在坐骨直肠窝内形成新的瘘管通道，导致多个外口，同时仍不符合该法则。然而，这些长瘘管实际上可归类为简单瘘管，起源于隐窝腺性括约肌间区域或仅穿过部分外括约肌。唯一需要考虑的问题是伤口护理时间延长和误工时间。
