title: Non-sphincter splitting fistulectomy vs conventional fistulotomy for high trans-sphincteric fistula-in-ano: a prospective functional and manometric study.
abstract: OBJECTIVE
  This study compared the clinical and physiological results of non-sphincter splitting fistulectomy (N-SSF) with those of sphincter splitting fistulotomy (SSF) for treatment of high trans-sphincteric fistula-in-ano.
  
  
  METHODS
  A prospective, observational study was undertaken in 70 consecutive patients with high trans-sphincteric fistula treated by SSF (n = 35) or N-SSF (n = 35). Anal manometry was performed before and 3 months after surgery. Anal continence was assessed using the Cleveland Clinic Florida Incontinence Score.
  
  
  RESULTS
  There was no difference between the two groups in age, gender, presence of horseshoe extension, preoperative incontinence score and manometric values. The incidence of recurrence was similar between the two groups. The postoperative incontinence score of the SSF group was significantly higher than that of the N-SSF group (1.9 +/- 2.9 vs 1.1 +/- 2.9, P = 0.0347). Maximum resting pressure showed significant decrease after surgery in both groups (83.2 to 56.1 mmHg, P = 0.0001 and 85.1 to 58.4 mmHg, P = 0.0001). Voluntary contraction pressure and functional anal canal length did not change after N-SSF (137.6 to 138.2 mmHg, P = 0.9524 and 4.06 to 4.07 cm, P = 0.9524), but significantly decreased after SSF (120.2 to 96.7 mmHg, P = 0.0085 and 4.12 to 3.74 cm, P = 0.0183).
  
  
  CONCLUSIONS
  Non-sphincter splitting fistulectomy for high trans-sphincteric fistula provided better functional results than fistulotomy. Less impairment of anal continence was achieved possibly not only by maintenance of the external anal sphincter function but also by preservation of the length of the high-pressure zone.
authors.affiliation: Department of Surgery, Matsushima Hospital Colo-Proctology Center, 19-11 Tobehoncho, Yokohama, Japan. toyozo7@yahoo.co.jp
authors.forename: Takayuki
authors.initials: T
authors.lastname: Toyonaga
authors.forename: Makoto
authors.initials: M
authors.lastname: Matsushima
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Kazunori
authors.initials: K
authors.lastname: Suzuki
authors.forename: Nobuhito
authors.initials: N
authors.lastname: Sogawa
authors.forename: Hiroki
authors.initials: H
authors.lastname: Kanyama
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Shimojima
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Hatakeyama
authors.forename: Masao
authors.initials: M
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D012003:Rectal Fistula / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome