Immediate reconstruction of the anal sphincter after fistulectomy in the management of complex anal fistulas

Abstract

An analysis was made of the indications and outcome of immediate reconstruction of the anal sphincter after fistulectomy in the management of a selected group of patients who were at risk of post-operative incontinence. A total of 31 patients underwent surgery, with 25 high trans-sphincteric fistulas (80.6%), four low trans-sphincteric fistulas (12.9%), and two suprasphincteric fistulas (6.5%). The median post-operative stay was 7.0 days, with a median follow up of 24.0 months. We describe one case (3.2%) of post-operative infection and dehiscence of the muscle suture. The fistula recurred in three patients (9.7%). At the end of follow up of 25 patients with full preoperative continence, five patients (20.0%) presented with perianal soiling and one (4.0%) had incontinence to flatus. Sphincter reconstruction after fistulectomy constitutes a management option that should be considered in the treatment of certain fistulas. It allows both rapid recovery and the preservation of anal function.

Fistulotomy or fistulectomy and primary sphincteroplasty for anal fistula (FIPS): a systematic review

“…This concept was clearly illustrated in a study by van der Hagen et al [45], where the recurrence rate in patients treated by flap or fistulotomy was 22 and 7 % after 12 months and 63 and 39 % after 72 months, respectively. In this review, the weighted average duration of follow-up was 28.9 months, and the success rate was about 90 %, which was also the case in the studies with at least 2 [20,33,34] or 5 years [38] of follow-up. Moreover, the data that emerged from this systematic review seem to confirm the need for a longterm follow-up after fistula surgery: The medium times to recurrence were 20.0 and 17.3 months in the studies by Arroyo et al and Ratto et al,respectively [20,38].…”

“…One hundred and seven records were excluded for various reasons; therefore, 17 full-text articles were assessed for eligibility. Fourteen reports satisfied the inclusion criteria [19,20,[28][29][30][31][32][33][34][35][36][37][38][39], while three studies were excluded because their results were updated in a more recent article [40][41][42] (Fig. 1).…”

“…The use of complete bowel preparation was described in seven series [19,29,33,34,36,38,39], while Ratto et al [20] preferred enemas. Ten studies reported pre-and/or postoperative administration of antibiotics [19,29,30,[32][33][34][36][37][38][39], and one study reported no use of antibiotics [20] ( Table 2).…”

“…Fistulectomy was performed in ten studies [19, 28-33, 35, 36, 39] and fistulotomy in four studies [20,34,37,38]. The reconstructive phase included end-to-end sphincteroplasty in 12 studies [19,20,28,[30][31][32][33][35][36][37][38][39] and overlapping sphincteroplasty in only two studies [29,34]. When reported, the weighted average duration of the surgical procedure was 26.5 min (range 20.9-35.0 min), and the weighted average duration of postoperative stay was 4.5 days (range 1.3-7.3 days) ( Table 2).…”

Fistulotomy With End-To-End Primary Sphincteroplasty for Anal Fistula

“…fiPs has also demonstrated a low risk of morbidity in other published series (table 5). [18][19][20][21][22] in studies that adopted an overlapping sphincteroplasty, 17,23,24 no dehiscence was reported (table 5). however, it should be taken into account that, when performed to treat fecal incontinence due to anal fistula surgery, overlapping sphincteroplasty can cause bleeding or infective complications in up to 25% of the patients.…”