BACKGROUND: Optimal treatment for high/complex anal fistulas is uncertain. We have studied one surgeon's results over a ten-year period, concentrating on high fistulas. METHODS: Demographic, fistula anatomy and treatment data were recorded for all patients undergoing surgery for anal fistula. Outcome data were recorded for patients who had been followed up for a minimum of 4 weeks. RESULTS: One hundred and eighty patients were studied. Outcome data were available for 52 low and 84 high fistulas. Fistulotomy was performed for 50 low and 48 high fistulas, with closure rates of 98 and 96%, respectively. There was fistula recurrence in two patients with high fistulas. Symptoms of sphincter disturbance were similar after lay open of low and high fistulas. Treatment of a high fistula by drainage seton had a lower rate of inadvertent passage of flatus but a similar rate of minor soiling compared with fistulotomy. CONCLUSIONS: Lay open of low and high anal fistulas is effective and associated with a similar, predictable rate of minor sphincter disturbance, amounting to a third to one quarter of patients with mild leakage of flatus and mucus. Patients with high fistulas can be cured, but when a surgeon is in doubt, a second opinion at an expert centre should be sought before definitive intervention.
BACKGROUND: Optimal treatment for high/complex anal fistulas is uncertain. We have studied one surgeon's results over a ten-year period, concentrating on high fistulas. METHODS: Demographic, fistula anatomy and treatment data were recorded for all patients undergoing surgery for anal fistula. Outcome data were recorded for patients who had been followed up for a minimum of 4 weeks. RESULTS: One hundred and eighty patients were studied. Outcome data were available for 52 low and 84 high fistulas. Fistulotomy was performed for 50 low and 48 high fistulas, with closure rates of 98 and 96%, respectively. There was fistula recurrence in two patients with high fistulas. Symptoms of sphincter disturbance were similar after lay open of low and high fistulas. Treatment of a high fistula by drainage seton had a lower rate of inadvertent passage of flatus but a similar rate of minor soiling compared with fistulotomy. CONCLUSIONS: Lay open of low and high anal fistulas is effective and associated with a similar, predictable rate of minor sphincter disturbance, amounting to a third to one quarter of patients with mild leakage of flatus and mucus. Patients with high fistulas can be cured, but when a surgeon is in doubt, a second opinion at an expert centre should be sought before definitive intervention.
Authors: Francisco Perez; Antonio Arroyo; Pilar Serrano; Ana Sánchez; Fernando Candela; Maria Teresa Perez; Rafael Calpena Journal: Am J Surg Date: 2006-07 Impact factor: 2.565
Authors: Gordon N Buchanan; Clive I Bartram; Robin K S Phillips; Stuart W T Gould; Steve Halligan; Tim A Rockall; Paul Sibbons; Richard G Cohen Journal: Dis Colon Rectum Date: 2003-09 Impact factor: 4.585
Authors: S O Adegbola; K Sahnan; G Pellino; P J Tozer; A Hart; R K S Phillips; J Warusavitarne; O D Faiz Journal: Tech Coloproctol Date: 2017-10-29 Impact factor: 3.781
Authors: P Tozer; S Sala; V Cianci; K Kalmar; G K Atkin; G Rahbour; P Ranchod; A Hart; R K S Phillips Journal: J Gastrointest Surg Date: 2013-09-04 Impact factor: 3.452