FUNCTIONAL OUTCOME OF FISTULECTOMY WITH PRIMARY REPAIR OF SPHINCTER IN TREATMENT OF COMPLEX FISTULA IN ANO
DOI:
https://doi.org/10.22159/ajpcr.2025v18i3.54040Keywords:
Fistulectomy, Primary sphincter repair, Fistula in ano, Surgery, Complex fistula in anoAbstract
Objective: Afistula in ano is a common surgical issue encountered all over the world. There are multiple treatment options, especially in transphincteric fistulas, creating dilemma in choosing the best. However, fistulectomy is a time-tested treatment with a low recurrence rate, but stool incontinence due to anal sphincter injury is the two most severe side effects of treating anal fistulas. The objective of the study was to evaluate the surgical outcome of “fistulectomy with primary repair” for the treatment of complex fistula in ano involving anal sphincter.
Methods: The prospective observational study was conducted including 43 patients undergoing fistulectomy with primary repair of sphincter for fistula in ano. The following outcomes were evaluated on follow-up: Incontinence, recurrence, pain, bleeding, wound dimension, healing time, and length of hospital stay.
Results: In the present study, it was observed that fecal incontinence was present in none of the patients in the post-operative period while 4 patients (9%) had mild flatus incontinence. Only one patient had a recurrence of fistula at post-operative day 180.
Conclusion: For the treatment of complex anal fistulas, Fistulectomy with Primary Repair of Sphincter is a safe and efficient procedure that has a promising success rate and also has minimal impact on continence
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References
Fazio VW. Complex anal fistulae. Gastroenterol Clin North Am. 1987;16(1):93-114. doi: 10.1016/S0889-8553(21)00483-0, PMID: 3298058
Cadeddu F, Salis F, Lisi G, Ciangola I, Milito G. Complex anal fistula remains a challenge for colorectal surgeon. Int J Colorectal Dis. 2015;30(5):595-603. doi: 10.1007/s00384-014-2104-7, PMID: 25566951
Parkash S, Lakshmiratan V, Gajendran V. Fistula-in-ano: Treatment by fistulectomy, primary closure and reconstitution. Aust N Z J Surg. 1985;55(1):23-7. doi: 10.1111/j.1445-2197.1985.tb00849.x, PMID: 3863565
Ratto C, Litta F, Donisi L, Parello A. Fistulotomy or fistulectomy and primary sphincteroplasty for anal fistula (FIPS): A systematic review. Tech Coloproctol. 2015;19(7):391-400. doi: 10.1007/s10151-015- 1323-4, PMID: 26062740
Ommer A, Herold A, Berg E, Fürst A, Sailer M, Schiedeck T, et al. Cryptoglandular anal fistulas. Dtsch Ärztebl Int. 2011;108(42):707-13. doi: 10.3238/arztebl.2011.0707, PMID: 22114639
Christiansen J, Rønholt C. Treatment of recurrent high anal fistula by total excision and primary sphincter reconstruction. Int J Colorectal Dis. 1995;10(4):207-9. doi: 10.1007/BF00346220, PMID: 8568405
Bernal-Sprekelsen J, Landente F, Morera F, Ripoll F, De Tursi L, Garcia- Granero MM. Treatment of anal fistulae followed by sphincteroplasty. Color Dis Suppl. 2008;2:51.
Lux N, Athanasiadis S. Functional results following fistulectomy with primary muscle suture in high anal fistula. A prospective clinical and manometric study. Chirurg. 1991;62(1):36-41. PMID: 2026067
Perez F, Arroyo A, Serrano P, Sánchez A, Candela F, Perez MT, et al. Randomized clinical and manometric study of advancement flap versus fistulotomy with sphincter reconstruction in the management of complex fistula-in-ano. Am J Surg. 2006;192(1):34-40. doi: 10.1016/j. amjsurg.2006.01.028, PMID: 16769272
Roig JV, García-Armengol J, Jordán JC, Moro D, García-Granero E, Alós R. Fistulectomy and sphincteric reconstruction for complex cryptoglandular fistulas. Colorectal Dis. 2010;12(7 Online):e145-52. doi: 10.1111/j.1463-1318.2009.02002.x, PMID: 19604292
Lewis A. Core out. In: Phillips RK, Lunniss PJ, editors. Anal Fistula: Surgical Evaluation Andmanagement. London, UK: Chapman and Hall; 1996. p. 81-6.
Seyfried S, Bussen D, Joos A, Galata C, Weiss C, Herold A. Fistulectomy with primary sphincter reconstruction. Int J Colorectal Dis. 2018;33(07):911-8. doi: 10.1007/s00384-018-3042-6, PMID: 29651553
19 Farag AFA, Elbarmelgi MY, Mostafa MY, Mashhour AN. One stage fistulectomy for high anal fistula with reconstruction of anal sphincter without fecal diversion. Asian J Surg. 2019;42(08):792-6. doi: 10.1016/j.asjsur.2018.12.005, PMID: 30738718
Iqbal N, Dilke SM, Geldof J, Sahnan K, Adegbola S, Bassett P, et al. Is fistulotomy with immediate sphincter reconstruction (FISR) a sphincter preserving procedure for high anal fistula? A systematic review and meta-analysis. Colorectal Dis. 2021;23(12):3073-89. doi: 10.1111/ codi.15945, PMID: 34623747
Maqbool J, Mehraj A, Shah ZA, Aziz G, Wani RA, Parray FQ, et al. Fistulectomy and incontinence: Do we really need to worry? Med Pharm Rep. 2022;95(1):59-64. doi: 10.15386/mpr-2045, PMID: 35720244
Verma A, Kothari R, Sharma D, Agarwal P. Cutting of sphincter in fistulectomy with primary closure in complex fistula-in-ano: Is it feasible? J Coloproctol. 2023;43(3):e204-7. doi: 10.1055/s-0043- 1774726
Hirschburger M, Schwandner T, Hecker A, Kierer W, Weinel R, Padberg W. Fistulectomy with primary sphincter reconstruction in the treatment of high transsphincteric anal fistulas. Int J Colorectal Dis. 2014;29(2):247-52. doi: 10.1007/s00384-013-1788-4, PMID: 24337835
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