Excision of anal fistula with closure of the internal opening: functional and manometric results.
OBJECTIVE
The aim of this study was to evaluate the results concerning recurrence and continence after sphincter-saving surgery for fistula-in-ano.


METHODS
Forty-two patients with anal fistula traversing the sphincter were operated on with fistula excision and closure of the internal opening. Patients answered a questionnaire concerning bowel habits and continence before and 3 and 12 months after surgery. A subgroup of 19 patients were also examined with anal manometry.


RESULTS
Twenty-three (55 percent) patients healed primarily after surgery and a further 10 (24 percent) after one reoperation, whereas 7 (17 percent) required 2 to 4 reoperations until healed. In two patients therapy was changed to cutting seton treatment. After 1 year 21 of 36 (58 percent) patients reported improved or unaffected continence and 11 (31 percent) reported a slight and 4 (11 percent) a major decrease in continence. Detailed data on preoperative continence were missing for five patients, and one had a colostomy at late follow-up. Anal manometry showed a significant decrease in resting pressure after three months and a further decrease in both resting and squeeze pressures after one year.


CONCLUSIONS
Surgery for anal fistula with excision and advancement flap has a fairly high initial recurrence rate but a good final success rate. A decrease in continence is seen also after this kind of surgery for anal fistula. Manometric results suggest that this is associated with an impaired internal anal sphincter function.
Gustafsson
Ulla-Maria
UM
Department of Surgery, University Hospital, Uppsala, Sweden.
Graf
Wilhelm
W
D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000502:physiology / Q000601:surgery*; D005242:Fecal Incontinence / Q000209:etiology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D012003:Rectal Fistula / Q000473:pathology / Q000601:surgery*; D012008:Recurrence; D013524:Surgical Flaps; D016896:Treatment Outcome