title: Fistulectomy with primary sphincter reconstruction in the treatment of high transsphincteric anal fistulas.
abstract: OBJECTIVE
  The treatment of transsphincteric anal fistulas is a challenge between recurrence rate and incontinence. Many surgical and conservative procedures have been described in the treatment of anal fistulas. Fistulectomy and primary sphincter reconstruction (FPSR) has not gained great popularity in this field due to the risk of sphincter damage. The aim of this study is to evaluate FPSR in the treatment of transsphincteric fistulas.
  
  
  METHODS
  We retrospectively analyzed 50 patients with high transsphincteric fistulas of cryptoglandular origin that were treated with FPSR between 2005 and 2008. Preoperative assessment included physical and proctologic examination. Continence and pain scores were evaluated preoperatively and postoperatively.
  
  
  RESULTS
  In our 50 patients, 22 patients (44 %) had a previous proctologic operation and 11 patients (22 %) presented with recurrent fistulas. The fistulas existed for an average of 8 months. The operation time was 28 ± 16 min. Mean follow-up was 22± months. The fistula healed in 44 patients (88 %) who developed no recurrence. In five patients (10 %), the fistula healed, but they developed a recurrence in the observation period. In one patient (2 %), the fistula did not heal. Three patients developed low-grade incontinence for flatus, and one patient with 2° incontinence improved. Preoperatively and postoperatively calculated continence and pain scores showed a slight but significant elevation in the Clinical Continence Score, the German Society of Coloproctology Score showed no significant difference, and preexisting pain was reduced significantly by surgery.
  
  
  CONCLUSIONS
  FPSR is a safe surgical procedure for the treatment of high transsphincteric anal fistula. The primary healing rate is high with a low risk of recurrence or incontinence.
authors: Department of General, Visceral, Thoracic, Transplantation- and Pediatric Surgery, University Hospital Giessen, Rudolf-Buchheimstreet 7, 35395, Giessen, Germany.
authors: Markus
authors: M
authors: Hirschburger
authors: Thilo
authors: T
authors: Schwandner
authors: Andreas
authors: A
authors: Hecker
authors: Walter
authors: W
authors: Kierer
authors: Rolf
authors: R
authors: Weinel
authors: Winfried
authors: W
authors: Padberg
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000473:pathology* / Q000601:surgery*; D003710:Demography; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications / Q000209:etiology; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D012003:Rectal Fistula / Q000150:complications / Q000601:surgery*