Abstract
In a prospective study on 224 patients with so-called high-fistula in ano (189 transsphincteric, 35 suprasphincteric) the long-term results of a sphinctersaving operation technique were assessed. The follow-up period was 1 to 7.5 years. This technique consists of onestage fistulectomy as well as of drainage of the intersphincteric space by internal sphincterotomy. The site of the former primary orifice of the fistula is adapted by multiple peranally performed single stitches, including mucosal advancement flap distal to the original fistulous opening. Postoperatively, 24 cases of suture leakage occurred (9% with the transsphincteric and 20% with the suprasphincteric fistula). 27 patient developed late complications like fistula recurrences or combinations of fistula and anal abscess (10.7% with the transsphincteric and 19.9% with the suprasphincteric fistula). Anal manometry was carried out preoperatively as well as postoperatively. A significant decrease in the postoperative resting pressure compared to the preoperative value was determined. The two fistula groups differed statistically both with regard to the resting pressure and the contraction pressure. Significant impairment of continence developed in 21% of patients with transsphincteric fistula but in 43% of patients with suprasphincteric fistula (intermittent fecal spoiling/use of perineal pads). The total percentage of complications rose with the number of previous fistula operations.
Résumé
Les résultats à long terme d'une technique préservant la fonction sphinctérienne ont été établis dans une étude prospective portant sur 224 patients porteurs de fistule anale haute (189 transsphinctériennes et 35 suprasphinctériennes). Le suivi va de 1 à 7,5 ans. La technique consiste en un temps à pratiquer une fistulectomie et un drainage de l'espace intersphinctérien par une sphinctérotomie interne. L'emplacement de l'ancien orifice primaire de la fistule est oblitéré par de multiples points de suture simples réalisés par voi per-anale comprenant un avancement de la muqueuse distale à l'orifice primaire. Dans la période post-opératoire immédiate, 24 désunions de suture ont été observées (9% en cas de fistule transsphinctérienne et 20% en cas de fistule suprasphinctérienne). Vingt-sept patients ont développé des complications tardives: récidives de la fistule ou combinaison d'abcès et de fistules (10,7% lors de fistules transsphinctériennes et 19,9% en cas de fistules suprasphinctériennes). Une manométrie anale a été réalisée en pré-opératoire de même qu'en post-opératoire. Une diminution significative de la pression de repos a été observée en post-opératoire comparativement aux valeurs pré-opératoires. Les deux types de fistule diffèrent statistiquement de manière significative tant en ce qui concerne la pression résiduelle de repos que la pression de contraction volontaire. Des troubles significatifs de la continence se sont développés chez 21% des patients avec des fistules transsphinctériennes et chez 43% des patients avec des fistules suprasphinctériennes (fecal soiling nécessitant de porter une garniture). Le taux de complications augmente avec le nombre d'opérations antérieures.
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Athanasiadis, S., Köhler, A. & Nafe, M. Treatment of high anal fistulae by primary occlusion of the internal ostium, drainage of the intersphincteric space, and mucosal advancement flap. Int J Colorect Dis 9, 153–157 (1994). https://doi.org/10.1007/BF00290193
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DOI: https://doi.org/10.1007/BF00290193