[One-stage surgery of high trans- and supra-sphincter anal fistula using primary fistulectomy and occlusion of the internal fistula ostium. A prospective study of 169 patients]

Abstract

In a prospective study on 169 patients with a so-called high fistula-in-ano (147 transsphincteric, 22 suprasphincteric) the value of a sphincter-saving operation technique was assessed. This technique consists of one-stage 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. The perianal part of the wound is left to heal by second intention. Post-operatively, 19 cases of suture leakage occurred (9.5% with the transsphincteric and 23% with the suprasphincteric fistula, resp.). 32 patients (19%) had to have repeated surgery because of recurrent abscess or fistula or because of suture leakage (mean follow-up 3.2 years). Anal manometry was carried out preoperatively as well as postoperatively. It revealed a decrease in anal resting and squeezing pressure of 10 to 40% with a mean about 30%. Of the patients who had not been operated on previously, an impairment of continence developed in 15% postoperatively. This percentage rose up to 40% according to the rising number of previous fistula operations. The main problem in these cases was soiling. Total anorectal incontinence for formed stool did not occur.