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Open Access 03-02-2025 | Fecal Incontinence

Fistulectomy and primary sphincter reconstruction for high cryptoglandular anal fistula: a retrospective cohort study with long-term results

Authors: Karam Matlub Sørensen, Niels Qvist

Published in: Surgical Endoscopy

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Abstract

Background

Surgical repair for high anal fistulas is challenging and can be associated with impaired functional outcomes. This study evaluated the long-term results of transsphincteric fistulectomy with primary sphincter repair for high anal fistulas in terms of recurrence, wound healing, fecal incontinence, and quality of life.

Method

This retrospective cohort study included patients who underwent surgical repair for high anal fistulas between 2006 and 2015. Data were collected by reviewing patients’ electronic hospital records, including demographic characteristics, medical conditions, surgical findings, performed procedures, and follow-up data until the last recorded visit. Functional outcomes were assessed using self-reported online questionnaires for quality of life (RAND SF-36) and fecal incontinence (Wexner score).

Results

Fifty-five patients were included. Primary healing was achieved in 42 (76%) patients, while 13 (24%) experienced recurrence. Following reoperations for recurrence, an additional 12 patients achieved healing, resulting in an overall healing rate of 98%. The median Wexner score was significantly higher in reoperated patients, and the median scores across all eight parameters of the RAND SF-36 were lower. None of the patients required proctectomy, and two ended with permanent stomas.

Conclusion

Surgery for high anal fistulas is associated with a high success rate, but reoperations for recurrence are linked to considerable impairment in functional outcomes.
Literature
1.
go back to reference Steele SR, Kumar R, Feingold DL, Rafferty JL, Buie WD, Standards Practice Task Force of the American Society of Colon and Rectal Surgeons (2011) Practice parameters for the management of perianal abscess and fistula-in-ano. Dis Colon Rectum 54:1465–1474CrossRefPubMed Steele SR, Kumar R, Feingold DL, Rafferty JL, Buie WD, Standards Practice Task Force of the American Society of Colon and Rectal Surgeons (2011) Practice parameters for the management of perianal abscess and fistula-in-ano. Dis Colon Rectum 54:1465–1474CrossRefPubMed
2.
3.
5.
go back to reference Bhat S, Xu W, Varghese C, Dubey N, Wells CI, Harmston C, O’Grady G, Bissett IP, Lin AY (2023) Efficacy of different surgical treatments for management of anal fistula: a network meta-analysis. Tech Coloproctol 27:827–845CrossRefPubMedPubMedCentral Bhat S, Xu W, Varghese C, Dubey N, Wells CI, Harmston C, O’Grady G, Bissett IP, Lin AY (2023) Efficacy of different surgical treatments for management of anal fistula: a network meta-analysis. Tech Coloproctol 27:827–845CrossRefPubMedPubMedCentral
7.
go back to reference Farag AFA, Elbarmelgi MY, Mostafa M, Mashhour AN (2019) One stage fistulectomy for high anal fistula with reconstruction of anal sphincter without fecal diversion. Asian J Surg 42:792–796CrossRefPubMed Farag AFA, Elbarmelgi MY, Mostafa M, Mashhour AN (2019) One stage fistulectomy for high anal fistula with reconstruction of anal sphincter without fecal diversion. Asian J Surg 42:792–796CrossRefPubMed
8.
go back to reference Roig GA, Jordan, Alos, Solana (1999) Immediate reconstruction of the anal sphincter after fistulectomy in the management of complex anal fistulas. Colorectal Dis 1:137–140CrossRefPubMed Roig GA, Jordan, Alos, Solana (1999) Immediate reconstruction of the anal sphincter after fistulectomy in the management of complex anal fistulas. Colorectal Dis 1:137–140CrossRefPubMed
9.
go back to reference Seyfried S, Bussen D, Joos A, Galata C, Weiss C, Herold A (2018) Fistulectomy with primary sphincter reconstruction. Int J Colorectal Dis 33:911–918CrossRefPubMed Seyfried S, Bussen D, Joos A, Galata C, Weiss C, Herold A (2018) Fistulectomy with primary sphincter reconstruction. Int J Colorectal Dis 33:911–918CrossRefPubMed
10.
go back to reference Ratto C, Litta F, Parello A, Zaccone G, Donisi L, De Simone V (2013) Fistulotomy with end-to-end primary sphincteroplasty for anal fistula: results from a prospective study. Dis Colon Rectum 56:226–233CrossRefPubMed Ratto C, Litta F, Parello A, Zaccone G, Donisi L, De Simone V (2013) Fistulotomy with end-to-end primary sphincteroplasty for anal fistula: results from a prospective study. Dis Colon Rectum 56:226–233CrossRefPubMed
11.
go back to reference Ratto C, Grossi U, Litta F, Di Tanna GL, Parello A, De Simone V, Tozer P, Zimmerman DED, Maeda Y (2019) Contemporary surgical practice in the management of anal fistula: results from an international survey. Tech Coloproctol 23:729–741CrossRefPubMedPubMedCentral Ratto C, Grossi U, Litta F, Di Tanna GL, Parello A, De Simone V, Tozer P, Zimmerman DED, Maeda Y (2019) Contemporary surgical practice in the management of anal fistula: results from an international survey. Tech Coloproctol 23:729–741CrossRefPubMedPubMedCentral
12.
go back to reference Bjorner JB, Thunedborg K, Kristensen TS, Modvig J, Bech P (1998) The Danish SF-36 Health Survey: translation and preliminary validity studies. J Clin Epidemiol 51:991–999CrossRefPubMed Bjorner JB, Thunedborg K, Kristensen TS, Modvig J, Bech P (1998) The Danish SF-36 Health Survey: translation and preliminary validity studies. J Clin Epidemiol 51:991–999CrossRefPubMed
13.
go back to reference Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97CrossRefPubMed Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97CrossRefPubMed
14.
go back to reference von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, Initiative S (2008) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61:344–349CrossRef von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, Initiative S (2008) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61:344–349CrossRef
15.
go back to reference Sandborn WJ, Fazio VW, Feagan BG, Hanauer SB, Committee AGACP (2003) AGA technical review on perianal Crohn’s disease. Gastroenterology 125:1508–1530CrossRefPubMed Sandborn WJ, Fazio VW, Feagan BG, Hanauer SB, Committee AGACP (2003) AGA technical review on perianal Crohn’s disease. Gastroenterology 125:1508–1530CrossRefPubMed
16.
go back to reference Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, McLeod L, Delacqua G, Delacqua F, Kirby J, Duda SN, R. EDCap Consortium (2019) The REDCap consortium: building an international community of software platform partners. J Biomed Inform 95:103208CrossRefPubMedPubMedCentral Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, McLeod L, Delacqua G, Delacqua F, Kirby J, Duda SN, R. EDCap Consortium (2019) The REDCap consortium: building an international community of software platform partners. J Biomed Inform 95:103208CrossRefPubMedPubMedCentral
17.
go back to reference Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377–381CrossRefPubMed Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377–381CrossRefPubMed
18.
go back to reference Ratto C, Litta F, Donisi L, Parello A (2015) Fistulotomy or fistulectomy and primary sphincteroplasty for anal fistula (FIPS): a systematic review. Tech Coloproctol 19:391–400CrossRefPubMed Ratto C, Litta F, Donisi L, Parello A (2015) Fistulotomy or fistulectomy and primary sphincteroplasty for anal fistula (FIPS): a systematic review. Tech Coloproctol 19:391–400CrossRefPubMed
19.
go back to reference Perez F, Arroyo A, Serrano P, Sanchez A, Candela F, Perez MT, Calpena R (2006) Randomized clinical and manometric study of advancement flap versus fistulotomy with sphincter reconstruction in the management of complex fistula-in-ano. Am J Surg 192:34–40CrossRefPubMed Perez F, Arroyo A, Serrano P, Sanchez A, Candela F, Perez MT, Calpena R (2006) Randomized clinical and manometric study of advancement flap versus fistulotomy with sphincter reconstruction in the management of complex fistula-in-ano. Am J Surg 192:34–40CrossRefPubMed
20.
go back to reference Roig JV, Garcia-Armengol J, Jordan JC, Moro D, Garcia-Granero E, Alos R (2010) Fistulectomy and sphincteric reconstruction for complex cryptoglandular fistulas. Colorectal Dis 12:e145–e152CrossRefPubMed Roig JV, Garcia-Armengol J, Jordan JC, Moro D, Garcia-Granero E, Alos R (2010) Fistulectomy and sphincteric reconstruction for complex cryptoglandular fistulas. Colorectal Dis 12:e145–e152CrossRefPubMed
21.
go back to reference Sorensen KM, Moller S, Qvist N (2021) Video-assisted anal fistula treatment versus fistulectomy and sphincter repair in the treatment of high cryptoglandular anal fistula: a randomized clinical study. BJS Open 5:zrab097CrossRefPubMedPubMedCentral Sorensen KM, Moller S, Qvist N (2021) Video-assisted anal fistula treatment versus fistulectomy and sphincter repair in the treatment of high cryptoglandular anal fistula: a randomized clinical study. BJS Open 5:zrab097CrossRefPubMedPubMedCentral
22.
go back to reference Awad PBA, Hassan BHA, Awad KBA, Elkomos BE, Nada MAM (2023) A comparative study between high ligation of the inter-sphincteric fistula tract via lateral approach versus fistulotomy and primary sphincteroplasty in high trans-sphincteric fistula-in-ano: a randomized clinical trial. BMC Surg 23:224CrossRefPubMedPubMedCentral Awad PBA, Hassan BHA, Awad KBA, Elkomos BE, Nada MAM (2023) A comparative study between high ligation of the inter-sphincteric fistula tract via lateral approach versus fistulotomy and primary sphincteroplasty in high trans-sphincteric fistula-in-ano: a randomized clinical trial. BMC Surg 23:224CrossRefPubMedPubMedCentral
23.
go back to reference Iqbal N, Dilke SM, Geldof J, Sahnan K, Adegbola S, Bassett P, Tozer P (2021) Is fistulotomy with immediate sphincter reconstruction (FISR) a sphincter preserving procedure for high anal fistula? A systematic review and meta-analysis. Colorectal Dis 23:3073–3089CrossRefPubMed Iqbal N, Dilke SM, Geldof J, Sahnan K, Adegbola S, Bassett P, Tozer P (2021) Is fistulotomy with immediate sphincter reconstruction (FISR) a sphincter preserving procedure for high anal fistula? A systematic review and meta-analysis. Colorectal Dis 23:3073–3089CrossRefPubMed
Metadata
Title
Fistulectomy and primary sphincter reconstruction for high cryptoglandular anal fistula: a retrospective cohort study with long-term results
Authors
Karam Matlub Sørensen
Niels Qvist
Publication date
03-02-2025
Publisher
Springer US
Published in
Surgical Endoscopy
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-025-11585-9
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