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. 2024 Dec;95(Suppl 1):6-13.
doi: 10.1007/s00104-024-02134-6. Epub 2024 Aug 16.

Evaluation of the outcomes of fistulotomy with primary sphincter reconstruction in the management of high trans-sphincteric fistula and supra-sphincteric fistula-in-ano : A single-center prospective cohort study

Basma Hussein Abdelaziz Hassan  1 , Philobater Bahgat Adly Awad  2 , Mostafa Mohamed Abdelaziz  2 , Mohammed Hossam  2 , Mohamed Ali Mohamed Nada  2
Affiliations

Evaluation of the outcomes of fistulotomy with primary sphincter reconstruction in the management of high trans-sphincteric fistula and supra-sphincteric fistula-in-ano : A single-center prospective cohort study

Basma Hussein Abdelaziz Hassan et al. Chirurgie (Heidelb). 2024 Dec.

Abstract
in English, German

Background: Supra-sphincteric and high trans-sphincteric fistula are very challenging procedures for both the patient and the surgeon. We aimed to evaluate the outcomes of anal sphincter repair in the management of supra-sphincteric and high trans-sphincteric fistula-in-ano in terms of postoperative wound infection, bleeding, incontinence to flatus or stool, and recurrence within 1 year.

Patients and methods: This single-center prospective cohort trial conducted from June 2020 to December 2023 at the Ain Shams University Hospitals included 20 patients who presented with supra-sphincteric or high trans-sphincteric fistula. There were nine (45%) male and 11 (55%) female patients, with a mean age of 41.5 years postoperatively.

Results: The mean duration of the procedure was 90.3 min (SD ± 11.9). During the first 2 weeks, ten (50%) patients scored their postoperative pain as mild, eight (40%) as moderate, and two (10%) as severe. Wound infection occurred in two (10%) patients and postoperative bleeding in three (15%) patients in the form of spotting after defecation. There were no cases of incontinence to stool. However, there were three (15%) cases of incontinence to gases. There were two cases (10%) of recurrence at the 1‑year follow-up. Postoperative patient satisfaction was assessed on a 5‑point Likert scale after 2 weeks: One patient (5%) was very dissatisfied, three (15%) patients were dissatisfied, and two (10%) patients were unsure, while five (25%) patients were satisfied and nine (45%) were very satisfied.

Conclusion: Immediate sphincter repair in supra-sphincteric and high trans-sphincteric fistula through a lay-open procedure was determined to be safe, easier than classic operations, and associated with a low incidence of recurrence at the 1‑year follow-up and a high quality of life.

Zusammenfassung: HINTERGRUND: Suprasphinkterische und hohe transsphinkterische Fisteln stellen eine sehr große Herausforderung für den Patienten und den Chirurgen dar. Ziel der Studie war es, die Ergebnisse der Analsphinkterrekonstruktion bei der Behandlung suprasphinkterischer und hoher transsphinkterischer Analfisteln in Bezug auf postoperative Wundinfektion, Blutung, Inkontinenz für Wind oder Stuhl sowie Rezidivbildung innerhalb eines Jahres zu untersuchen.

Patienten und methoden: Die vorliegende prospektive Einzelzentrum-Kohortenstudie wurde von Juni 2020 bis Dezember 2023 an den Ain Shams University Hospitals, Kairo, Ägypten, an 20 Patienten durchgeführt, die sich mit einer suprasphinkterischen oder hohen transsphinkterischen Fistel vorstellten. Es handelte sich um 9 (45%) männliche und 11 (55%) weibliche Patienten mit einem Durchschnittsalter von 41,5 Jahren postoperativ.

Ergebnisse: Durchschnittlich dauerte die Operation 90,3 min (Standardabweichung, SD: ± 11,9). Während der ersten 2 Wochen beurteilten 10 (50%) Patienten ihre postoperativen Schmerzen als leicht, 8 (40%) als mittel und 2 (10%) als schwer. Eine Wundinfektion trat bei 2 (10%) Patienten und eine postoperative Blutung bei 3 (15%) Patienten in Form von Schmierblutungen nach dem Stuhlgang auf. Es gab keinen Fall von Stuhlinkontinenz. Jedoch bestand in 3 (15%) Fällen Windinkontinenz. Bei der Nachuntersuchung nach einem Jahr fanden sich 2 (10%) Fälle mit einem Rezidiv. Die postoperative Patientenzufriedenheit wurde nach 2 Wochen anhand einer 5‑Punkt-Likert-Skala beurteilt: Ein Patient (5%) war sehr unzufrieden, 3 (15%) waren unzufrieden, und 2 (10%) Patienten waren unsicher, während 5 (25%) Patienten zufrieden und 9 (45%) sehr zufrieden waren.

Schlussfolgerung: Die direkte Spinkterrekonstruktion bei suprasphinkterischen und hohen transsphinkterischen Fisteln mittels eines offenen Verfahrens stellte sich als sicher, einfacher als klassische Operationen und mit einer geringen Inzidenz von Rezidiven bei der Nachuntersuchung nach einem Jahr sowie einer hohen Lebensqualität verbunden heraus.

Keywords: Anal fistula; Incontinence; Postoperative outcome; Recurrence; Surgery.

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Conflict of interest statement

Declarations. Conflict of interest: B.H.A. Hassan, P.B.A. Awad, M.M. Abdelaziz, M. Hossam and M.A.M. Nada declare that they have no competing interests. For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case. To protect patients’ privacy and information, all methods were carried out in accordance with relevant guidelines and regulations and all experimental protocols were approved by Ain Shams University ethical committee with an informed consent had been taken from all the patients.

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