Fistulectomy and sphincteric reconstruction for complex cryptoglandular fistulas.
OBJECTIVE
Complex anal fistulas (CFs) are difficult to treat. Endoanal advancement flap (EAF) is one of the standard treatment options for such clinical conditions. Immediate sphincter repair after fistulectomy (ISR) is not commonly performed because of the fear of causing postoperative incontinence. The objective of this study was to compare the results of both techniques.


METHODS
We retrospectively analysed a prospectively entered database composed of 146 patients (112 M; 34 F), undergoing operations for CF of cryptoglandular origin. The patients were divided in two groups: Group A: (EAF); n = 71 patients; Group B: (ISR); n = 75 patients.


RESULTS
Forty-two fistulas (28.7%) were recurrent, 98 trans-sphincteric (TS) and 37 suprasphincteric (SS). Twenty-six (17.7%) patients had some degree of preoperative continence disturbances, 11 in Group A vs 15 in Group B (P = 0.47). After a mean follow up of 13 months (12-60), fistula persisted or recurred in 13 (18.3%) patients in Group A vs eight (10.6%) in Group B (P = 0.19) irrespective of the fistula type (TS or SS). Thirty-one (43.6%) patients in Group A vs 16 (21.3%) in Group B presented postoperative continence disturbances (P < 0.001). No changes were observed with the Faecal Incontinence Quality of Life Scale (FIQLS). Group A patients had a significant reduction of maximal rest pressure after surgery. After ISR, no significant changes in pressures were observed.


CONCLUSIONS
Immediate sphincter repair can be a therapeutic option in selected cases of CF, mainly when associated with incontinence or increased risk factors.
Roig
J V
JV
Coloproctology Unit, Department of General and Digestive Surgery, Consorcio Hospital General Universitario de Valencia, Valencia, Spain. roig_jvi@gva.es
García-Armengol
J
J
Jordán
J C
JC
Moro
D
D
García-Granero
E
E
Alós
R
R
D001003:Anal Canal / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods*; D005242:Fecal Incontinence / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D012003:Rectal Fistula / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D013524:Surgical Flaps; D016896:Treatment Outcome