Abstract
Background
Anal fistula is abnormal communication between the anal canal and the perianal skin or perineum or buttocks. Anal fistula is almost always a consequence of an anorectal abscess that was drained. While the abscess represents the acute phase of the disease, fistula represents the chronic phase as the fistulous pathway may persist in about 1/3 of cases.
Aim of the Work
In this study we will perform fistulotomy with primary sphincter repair in high cryptoglandular fistula with assessment of recurrence rate, incontinence rate and patient satisfaction according to pain score, wound healing, discharge and return to daily activity parameters.
Methods
This was prospective cohort study on 30 patients of high peri-anal fistulae and fistulotomy and reconstruction (primary suture repair) of anal sphincter was done., the patients were followed up 6 months postoperatively regarding their continence using Wexner score, recurrence, discharge and their return to work by scheduled outpatient clinical examination.
Results
Among 30 patients only three patients complaining usual incontinence mostly as post defecation soiling. Three patients reported anal fistula recurrence: One occurred at the 5th month, while the other two occurred at the 6th month after surgery. The procedure was well tolerated by the patients as most of them complaining only minimal pain and returned to work after two weeks without need of other stage like other procedures.
Conclusion
Fistulotomy with primary sphincter repair is an effective therapeutic option for patients with high anal fistula. Our study demonstrated that immediate reconstruction of the sphincters after fistulotomy achieved high success rates and low risk of postoperative fecal incontinence, compared to reported rates after simple fistulotomy.
Outcomes of primary anal sphincter repair after obstetric injury and evaluation of a novel three-choice assessment
