[Endo-anal and transperineal continence preserving closure techniques in surgical treatment of Crohn fistulas. A prospective long-term study of 186 patients].
Our aim was to review the results and to investigate the prognosis in a prospective study of aggressive surgical treatment in 186 patients (59% women, 41% men, age 18 to 65 years) treated during the past 9 1/2 years by conventional laying open of the fistula (n = 71), endorectal advancement flap repair (n = 89) and by fistulectomy without internal sphincterotomy (n = 37). 54 (29%) patients had intersphincteric, 57 (30.5%) transsphincteric, 10 (5.5%) suprasphincteric, 37 (20%) low rectovaginal and 28 (15%) had complex fistulas without internal opening. Four sphincter saving techniques were performed by the high and fistulas (n = 89) with primary occlusion of the intraanal ostium and endorectal mucosal flap (n = 29), endorectal advancement flap (n = 41), anodermal flap (n = 8) and transperineal repair with levator interposition (n = 11). Postoperatively 18 cases (20.2%) of suture leakage occurred, 27% in the mucosal flap group, 17.6% in the advancement flap group, 12.5% in the anodermal group, and 27% in the transperineal group. A complete primary healing of perianal wounds was noted in 73% of the patients within 6 months. The presence of rectal disease (n = 77) did not adversely influence the rate and duration of healing. Persistent or recurrent fistula occurs in 29 patients (15.6%), 22% in the sphincter saving group, 4% in the intersphincteric group and 32% in the complex type of fistulas. Disturbance of continence was observed in 9 patients (4.8%). Postoperatively, there was no significant change in resting anal pressure and maximum voluntary conctraction pressure in any fistula group (n = 104).


CONCLUSIONS
The presented clinical and functional long term results of patients with Crohn's fistulas underline the importance of experience in the treatment of perianal fistula disease. A successful treatment depends primarily on an aggressive therapeutic strategy and the appropriate method of operation.
Athanasiadis
S
S
Coloproktologische Abteilung, St. Joseph-Hospitals Laar, Duisburg.
Köhler
A
A
Weyand
G
G
Nafe
M
M
Kuprian
A
A
Oladeinde
I
I
D000293:Adolescent; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery; D003424:Crohn Disease / Q000601:surgery*; D005242:Fecal Incontinence / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D012003:Rectal Fistula / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D013524:Surgical Flaps / Q000379:methods; D016896:Treatment Outcome