Operative strategy for fistula-in-ano without division of the anal sphincter

A. K. Y. Fung, G. V. Card, N. P. Ross, S. R. Yule, E. H. Aly

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Abstract

INTRODUCTION: The treatment of perianal fistulas is diverse because no single technique is universally effective. Fistulotomy remains the most effective way of eradicating the pathology but it renders the patient at some risk of faecal incontinence, which many patients are reluctant to take. There are no data in the literature to indicate the healing rate of perianal fistulas when using an operative strategy that routinely avoids division of any part of the anal sphincter. The aim of this paper is to present the long-term results with an operative strategy that aims to avoid division of any part of the anal sphincter complex when treating all types of perianal fistulas, thereby minimising/eliminating the risk of postoperative incontinence.

METHODS: We report 54 consecutive cases of anal fistula that presented electively and as an emergency. Patients with known or subsequently diagnosed inflammatory bowel disease or malignancy were excluded from the study.

RESULT: Overall, 46 patients (37 male and 9 female) with a median age at presentation of 42 years (range: 19-73 years) were treated by lay-open of the subcutaneous tract of the perianal fistula and insertion of a loose seton for the part of the fistula tract related to the sphincter complex. The types of fistula treated were intersphincteric (89%), transsphincteric (4%) and high suprasphincteric (7%). The median length of time that the seton was left in place was 7 months (range: 1.5-24 months). The healing rate was 86% with a recurrence rate of 19% and a median follow-up duration of 42 months.

CONCLUSIONS: Patients who are reluctant to take any risk of faecal incontinence could be treated using an operative strategy that routinely avoids division of any part of the anal sphincter complex as this has a recurrence rate that compares well with other treatment modalities.

Original languageEnglish
Pages (from-to)461-467
Number of pages7
JournalAnnals of the Royal College of Surgeons of England
Volume95
Issue number7
DOIs
Publication statusPublished - Oct 2013

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Anal Canal
Fistula
Fecal Incontinence
Rectal Fistula
Recurrence
Inflammatory Bowel Diseases
Emergencies
Pathology
Therapeutics
Neoplasms

Keywords

  • Fistula-in-ano
  • Loose seton
  • Treatment

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Operative strategy for fistula-in-ano without division of the anal sphincter. / Fung, A. K. Y.; Card, G. V.; Ross, N. P.; Yule, S. R.; Aly, E. H.

In: Annals of the Royal College of Surgeons of England, Vol. 95, No. 7, 10.2013, p. 461-467.

Research output: Contribution to journalArticle

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abstract = "INTRODUCTION: The treatment of perianal fistulas is diverse because no single technique is universally effective. Fistulotomy remains the most effective way of eradicating the pathology but it renders the patient at some risk of faecal incontinence, which many patients are reluctant to take. There are no data in the literature to indicate the healing rate of perianal fistulas when using an operative strategy that routinely avoids division of any part of the anal sphincter. The aim of this paper is to present the long-term results with an operative strategy that aims to avoid division of any part of the anal sphincter complex when treating all types of perianal fistulas, thereby minimising/eliminating the risk of postoperative incontinence.METHODS: We report 54 consecutive cases of anal fistula that presented electively and as an emergency. Patients with known or subsequently diagnosed inflammatory bowel disease or malignancy were excluded from the study.RESULT: Overall, 46 patients (37 male and 9 female) with a median age at presentation of 42 years (range: 19-73 years) were treated by lay-open of the subcutaneous tract of the perianal fistula and insertion of a loose seton for the part of the fistula tract related to the sphincter complex. The types of fistula treated were intersphincteric (89{\%}), transsphincteric (4{\%}) and high suprasphincteric (7{\%}). The median length of time that the seton was left in place was 7 months (range: 1.5-24 months). The healing rate was 86{\%} with a recurrence rate of 19{\%} and a median follow-up duration of 42 months.CONCLUSIONS: Patients who are reluctant to take any risk of faecal incontinence could be treated using an operative strategy that routinely avoids division of any part of the anal sphincter complex as this has a recurrence rate that compares well with other treatment modalities.",
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note = "We would like to thank Mr ER MacDonald for his contribution in data collection during the early years of the study. The material in this paper was presented as a poster at the annual meeting of the American Society of Colon and Rectal Surgeons held in Vancouver, Canada, May 2011.",
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T1 - Operative strategy for fistula-in-ano without division of the anal sphincter

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AU - Card, G. V.

AU - Ross, N. P.

AU - Yule, S. R.

AU - Aly, E. H.

N1 - We would like to thank Mr ER MacDonald for his contribution in data collection during the early years of the study. The material in this paper was presented as a poster at the annual meeting of the American Society of Colon and Rectal Surgeons held in Vancouver, Canada, May 2011.

PY - 2013/10

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N2 - INTRODUCTION: The treatment of perianal fistulas is diverse because no single technique is universally effective. Fistulotomy remains the most effective way of eradicating the pathology but it renders the patient at some risk of faecal incontinence, which many patients are reluctant to take. There are no data in the literature to indicate the healing rate of perianal fistulas when using an operative strategy that routinely avoids division of any part of the anal sphincter. The aim of this paper is to present the long-term results with an operative strategy that aims to avoid division of any part of the anal sphincter complex when treating all types of perianal fistulas, thereby minimising/eliminating the risk of postoperative incontinence.METHODS: We report 54 consecutive cases of anal fistula that presented electively and as an emergency. Patients with known or subsequently diagnosed inflammatory bowel disease or malignancy were excluded from the study.RESULT: Overall, 46 patients (37 male and 9 female) with a median age at presentation of 42 years (range: 19-73 years) were treated by lay-open of the subcutaneous tract of the perianal fistula and insertion of a loose seton for the part of the fistula tract related to the sphincter complex. The types of fistula treated were intersphincteric (89%), transsphincteric (4%) and high suprasphincteric (7%). The median length of time that the seton was left in place was 7 months (range: 1.5-24 months). The healing rate was 86% with a recurrence rate of 19% and a median follow-up duration of 42 months.CONCLUSIONS: Patients who are reluctant to take any risk of faecal incontinence could be treated using an operative strategy that routinely avoids division of any part of the anal sphincter complex as this has a recurrence rate that compares well with other treatment modalities.

AB - INTRODUCTION: The treatment of perianal fistulas is diverse because no single technique is universally effective. Fistulotomy remains the most effective way of eradicating the pathology but it renders the patient at some risk of faecal incontinence, which many patients are reluctant to take. There are no data in the literature to indicate the healing rate of perianal fistulas when using an operative strategy that routinely avoids division of any part of the anal sphincter. The aim of this paper is to present the long-term results with an operative strategy that aims to avoid division of any part of the anal sphincter complex when treating all types of perianal fistulas, thereby minimising/eliminating the risk of postoperative incontinence.METHODS: We report 54 consecutive cases of anal fistula that presented electively and as an emergency. Patients with known or subsequently diagnosed inflammatory bowel disease or malignancy were excluded from the study.RESULT: Overall, 46 patients (37 male and 9 female) with a median age at presentation of 42 years (range: 19-73 years) were treated by lay-open of the subcutaneous tract of the perianal fistula and insertion of a loose seton for the part of the fistula tract related to the sphincter complex. The types of fistula treated were intersphincteric (89%), transsphincteric (4%) and high suprasphincteric (7%). The median length of time that the seton was left in place was 7 months (range: 1.5-24 months). The healing rate was 86% with a recurrence rate of 19% and a median follow-up duration of 42 months.CONCLUSIONS: Patients who are reluctant to take any risk of faecal incontinence could be treated using an operative strategy that routinely avoids division of any part of the anal sphincter complex as this has a recurrence rate that compares well with other treatment modalities.

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KW - Loose seton

KW - Treatment

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DO - 10.1308/003588413X13629960048956

M3 - Article

VL - 95

SP - 461

EP - 467

JO - Annals of the Royal College of Surgeons of England

JF - Annals of the Royal College of Surgeons of England

SN - 0035-8843

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ER -