Shehata Mahmoud Refaat, Abdelghany Mahmoud Mohamed Mohamed, Eid Gamal Abdel-Hamid Ahmed, Hanna Ragai Sobhi
Surgery Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
Tech Coloproctol. 2025 Jul 24;29(1):150. doi: 10.1007/s10151-025-03179-3.
High anal fistulae require more complicated treatment than low anal fistulae. Because of their complexity, this study aimed to assess the rerouting role in high anal fistulae treatment, as well as to assess recurrence and incontinence, and determine whether rerouting of the tract is a good option for treating high anal fistulae.
This is a prospective interventional study that was conducted on 83 patients with high perianal fistula, ranging in age from 18 to 72 years old, of both genders. All cases were assigned to history taking, laboratory investigations, clinical examination (general examination and local examination), and magnetic resonance imaging (MRI) for objective delineation of the fistulous tract and its association to the anal sphincters.
After a minimum follow-up period of 9 months, five cases (6.02%) experienced recurrence. Mild incontinence was reported in four patients (4.8%), while four patients (4.8%) developed infection. In addition, tract gangrene was observed in two patients (2.41%). In multivariate regression analysis, suprasphincteric fistulae and infection were independent predictors for recurrence.
The rerouting procedure is a feasible and safe surgical option for managing high transsphincteric perianal fistulae. It is associated with low postoperative complication rates, including short-term recurrence. It combines the advantages of fistulotomy and sphincter-preserving fistula surgery. However, further studies involving a large number of suprasphincteric fistula cases are needed to evaluate the efficacy of the rerouting technique in treating such fistulae.
高位肛瘘比低位肛瘘需要更复杂的治疗。鉴于其复杂性，本研究旨在评估改道在高位肛瘘治疗中的作用，以及评估复发和失禁情况，并确定瘘管改道是否是治疗高位肛瘘的一个好选择。
这是一项前瞻性干预性研究，对83例年龄在18至72岁之间的男女高位肛周瘘患者进行。所有病例均进行病史采集、实验室检查、临床检查（全身检查和局部检查）以及磁共振成像（MRI），以客观描绘瘘管及其与肛门括约肌的关系。
在至少9个月的随访期后，5例（6.02%）出现复发。4例患者（4.8%）报告有轻度失禁，4例患者（4.8%）发生感染。此外，2例患者（2.41%）出现瘘管坏疽。在多变量回归分析中，括约肌上肛瘘和感染是复发的独立预测因素。
改道手术是治疗高位经括约肌型肛周肛瘘的一种可行且安全的手术选择。它与低术后并发症发生率相关，包括短期复发。它结合了瘘管切开术和保留括约肌的肛瘘手术的优点。然而，需要进一步开展涉及大量括约肌上肛瘘病例的研究，以评估改道技术治疗此类肛瘘的疗效。
