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International Journal of Colorectal Disease

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01-09-2006 | Original Article

Prospective clinical and manometric study of fistulotomy with primary sphincter reconstruction in the management of recurrent complex fistula-in-ano

Authors: Francisco Perez, Antonio Arroyo, Pilar Serrano, Fernando Candela, Maria-Teresa Perez, Rafael Calpena

Published in: International Journal of Colorectal Disease | Issue 6/2006

Abstract

Background and aims

The aim of this study was to assess the results of fistulotomy with sphincter reconstruction in the management of recurrent complex fistula-in-ano in terms of recurrence and continence.

Patients and methods

Prospective study of 16 patients undergoing fistulotomy with sphincter reconstruction for recurrent complex fistula-in-ano was done. Preoperative and postoperative evaluation included physical examination, anal ultrasonography and anal manometry, with a 40-month follow-up. The Wexner Continence Grading Scale (0–20) was used to assess faecal continence.

Results

Fistulas were classified as high transsphincteric in 13 patients (81.3%), suprasphincteric in 2 (12.5%) and extrasphincteric in 1 patient (6.2%). Four patients (25%) had recurred twice or more. Eight patients (50%) complained of varying degrees of prior faecal incontinence. Their mean score decreased from 8.5 to 1.875 after surgery, and all the patients improved except for one whose score remained the same. On anal manometry, the differences between continent and incontinent patients before surgery [maximum resting pressure (MRP) 86.3 vs 57.6 mmHg, maximum squeeze pressure (MSP) 196.5 vs 138.6 mmHg] decreased after surgery (MRP 81.9 vs 63.7 mmHg, MSP 179.8 vs 159.3 mmHg). In fully continent patients, both the clinical score and manometric values were quite similar after surgery. Two fully continent patients (25%) developed occasional flatus incontinence and soiling, scoring two and three points, respectively. One patient recurred (6.25%) 6 months after surgery.

Conclusion

Fistulotomy with sphincter reconstruction seems to be an effective resource in the management of recurrent complex fistula-in-ano. It improves both anal continence and manometric values in incontinent patients without compromising them in fully continent ones.

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Title: Prospective clinical and manometric study of fistulotomy with primary sphincter reconstruction in the management of recurrent complex fistula-in-ano
Authors: Francisco Perez
Antonio Arroyo
Pilar Serrano
Fernando Candela
Maria-Teresa Perez
Rafael Calpena
Publication date: 01-09-2006
Publisher: Springer-Verlag
Published in: International Journal of Colorectal Disease / Issue 6/2006
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-005-0045-x

ACC 2024 Congress

Springer Medicine

Prospective clinical and manometric study of fistulotomy with primary sphincter reconstruction in the management of recurrent complex fistula-in-ano

Abstract

Background and aims

Patients and methods

Results

Conclusion

ACC 2024 Congress

Springer Medicine

Abstract

Background and aims

Patients and methods

Results

Conclusion

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