Muscle-filling procedure for transsphincteric fistulas

Abstract

The muscle-filling technique is an effective alternative procedure for transsphincteric fistulas.

Long-Term Results and Quality-of-Life Outcomes in Patients With Transsphincteric Fistulas After Muscle-Filling Procedure

“…9 The results obtained in the present study compare favorably with other studies in the treatment of posterior transsphincteric fistulas, with a 4.6 percent recurrence rate during a mean follow-up of 70 months. Iwadare et al 6 reported personal experience with a 1.5 percent recurrence rate. Recently, the results of sphincter-preserving procedures in Japan have a 7 to 10 percent recurrence rate for transsphincteric fistulas.…”

“…It also reduces the recurrence rate. 6,7 Even though the technique requires cutting the external and internal sphincters appropriately to make a pedicle muscle flap, proponents of the muscle-filling procedure believe the damage to the sphincter is far less than in other procedures, and the damage to the internal sphincter is virtually negligible, whereas opponents argue that the technique could produce unnecessary damage to the external sphincter. We think that because the dead space left by excision of the primary abscess is quite deep, it requires a wider wound for appropriate drainage, which would sacrifice more of the external sphincter.…”

“…The muscle-filling technique in the management of transsphincteric fistulas is based on the assumption that it takes advantage of the muscle flap that is killed to create the drainage, allows the wound to be smaller, and shortens healing time. 6,7 Although transsphincteric fistulas may be cured by laying open the entire fistula tracks, a surgical procedure that excises the primary abscess only is preferable, to avoid subsequent damage to sphincters and the creation of anal deformity. However, because primary abscess of the transsphincteric fistula is located in the deep postanal space (Courtney's space), when an appropriate drainage is created, the wound after excision itself can be severe.…”

“…1,6 Briefly, the operation is performed with the patient under spinal anesthesia in the prone jackknife position. First, the location of the primary opening of the anal fistula is identified.…”

Anal Sphincter Advancement Flap for Low Transsphincteric Anal Fistula

“…Various techniques have been reported in the literature with varying success. [2][3][4][5] This technical note illustrates a new technique that uses a distal portion of the anal sphincters and subcutaneous fat as an advancement flap to cover the internal opening of low transsphincteric fistulas.…”