Please use this identifier to cite or link to this item: https://hdl.handle.net/11000/31118

Long-term Evaluation of Fistulotomy and Immediate Sphincteroplasty as a Treatment for Complex Anal Fistula


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Title:
Long-term Evaluation of Fistulotomy and Immediate Sphincteroplasty as a Treatment for Complex Anal Fistula
Authors:
Aguilar-Martínez, María del Mar
Sánchez-Guillén, Luis  
Barber-Valles, Xavier
Alcaide-Quirós, María José
Bosch-Ramírez, Marina
López-Delgado, Alberto
Tozer, Phil  
Arroyo, Antonio  
Editor:
Wolters Kluwer
Department:
Departamentos de la UMH::Patología y Cirugía
Issue Date:
2021
URI:
https://hdl.handle.net/11000/31118
Abstract:
Background: Fistulotomy with immediate sphincteroplasty is a technique that can heal fistulas and decrease fecal incontinence more effectively than fistulotomy alone, in selected patients. Objective: We aimed to perform a long-term evaluation of fecal incontinence after fistulotomy and immediate sphincteroplasty in patients with complex anal fistula. Design: This prospective study included patients undergoing fistulotomy and immediate sphincteroplasty for complex anal fistula from January 2000 to December 2010. Settings: The study was conducted by 2 colorectal surgeons in the coloproctology unit of the General Hospital of Elche. Patients: We included patients aged ≥18 years with complex anal fistulas of cryptoglandular origin. Main outcome measures: Main outcomes were recurrence and continence after fistulotomy and immediate sphincteroplasty, according to fistula tract height and preoperative continence status. Results: A total of 107 patients were included; 68.2% were men, with a mean age of 48 years and mean fistula duration of 12.8 months. The range and median follow-up period were 84 to 204 and 96 months. Thirty-seven fistulas were not primary. The overall healing rate was 84.1%. Primary fistulas healed by the end of follow-up in 58 (82.9%) of 70 patients; recurrent fistulas healed in 32 (86.5%) of 37; high tracts healed in 31 (83.8%) of 37, and nonhigh fistulas healed in 59 (84.3%) of 70. Male sex (OR = 0.66 (95% CI, 0.20-2.13); p > 0.05) and recurrent fistulas (OR = 0.43 (95% CI, 0.11-1.68); p > 0.05) could have a protective effect against postoperative fecal incontinence; however, more studies with larger sample sizes are necessary to confirm this result, whereas high fistulas showed a 4-fold increased risk of incontinence (range, 1.22-13.06; p < 0.01). One in 5 high-tracts patients experienced continence deterioration. Limitations: This was a prospective study, and randomized clinical trials with more patients and longer follow-up are needed to compare fistulotomy and immediate sphincteroplasty with other sphincter-preserving techniques. Conclusions: Fistulotomy and immediate sphincteroplasty are good options for treating complex anal fistulas, especially for recurrent fistulas, men, and patients with nonhigh tracts, with acceptable recurrence and incontinence rates. See Video Abstract at http://links.lww.com/DCR/B498.
Keywords/Subjects:
Complex anal fistula
Continence
Fistulotomy
High fistula
Primary fistula
Sphinteroplasty
Knowledge area:
CDU: Ciencias aplicadas: Medicina: Patología. Medicina clínica. Oncología
Type of document:
application/pdf
Access rights:
info:eu-repo/semantics/closedAccess
DOI:
https://doi.org/10.1097/DCR.0000000000001800
Appears in Collections:
Artículos Patología y Cirugía



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