title: Anal function after ligation of the intersphincteric fistula tract.
abstract: BACKGROUND
  Although the ligation of the intersphincteric fistula tract is a promising anal sphincter-saving procedure for fistula-in-ano, the objective assessment of the sphincter preservation remains unknown.
  
  
  OBJECTIVE
  The primary end point was to measure the anal function before and after this procedure. The secondary end point measured was cure of the disease.
  
  
  METHODS
  This study is a prospective observational study.
  
  
  METHODS
  This study was conducted at the Department of Surgery, Kameda Medical Center, Japan, from March 2010 to August 2012.
  
  
  METHODS
  Twenty patients with transsphincteric or complex fistulas were evaluated.
  
  
  METHODS
  All patients underwent the ligation of the intersphincteric fistula tract with a loose seton for anal fistulas.
  
  
  METHODS
  Anal manometric study was performed before and 3 months after the procedure. Fecal incontinence was evaluated by using the fecal incontinence severity index. Failure was defined as nonhealing of the surgical wound or fistula.
  
  
  RESULTS
  The median operation time was 42 minutes. No intraoperative complications were documented. The median follow-up duration was 18 (3-32) months. No patients reported any incontinence postoperatively. The median score of the fecal incontinence severity index before and 3 months after the procedure was 0. The median maximum resting pressure measured before and after operation were 125 (71-175) cm H2O and 133 (95-169) cm H2O. The median maximum squeeze pressure measured before and after operation were 390 (170-815) cm H2O and 432 (200-902) cm H2O. There were no significant postoperative changes in either the resting pressure or the squeeze pressure. Primary healing was observed in 19 (95%) patients, and the median healing time was 7 weeks; 1 wound remained incompletely healed.
  
  
  CONCLUSIONS
  Short-term follow-up may not justify the use of the term definitive cure.
  
  
  CONCLUSIONS
  The ligation of the intersphincteric fistula tract with a loose seton showed no postoperative deterioration on anal sphincter function with favorable healing rates.
authors.affiliation: Department of Surgery, Kameda Medical Center, Chiba, Japan. a.tsunoda@kameda.jp
authors.forename: Akira
authors.initials: A
authors.lastname: Tsunoda
authors.forename: Haruki
authors.initials: H
authors.lastname: Sada
authors.forename: Takuya
authors.initials: T
authors.lastname: Sugimoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nagata
authors.forename: Nobuyasu
authors.initials: N
authors.lastname: Kano
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000503:physiopathology* / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008026:Ligation / Q000379:methods; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011184:Postoperative Period; D011312:Pressure; D011446:Prospective Studies; D012003:Rectal Fistula / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult