Fistulectomy and primary repair of wound and anal sphincter by Lasheen's sutures for high perianal fistula

2020 ◽  
Keyword(s):  
Anal Sphincter ◽  
Primary Repair ◽  
Perianal Fistula ◽  
High Perianal Fistula

scholarly journals Does a missed obstetric anal sphincter injury at time of delivery affect short-term functional outcome?

2018 ◽  
Vol 100 (1) ◽  
pp. 26-32 ◽  
Author(s):  
L Ramage ◽  
C Yen ◽  
S Qiu ◽  
C Simillis ◽  
C Kontovounisios ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Anal Sphincter ◽  
Short Form ◽  
Primary Repair ◽  
Obstetric Anal Sphincter Injury ◽  
Short Term ◽  
Sphincter Injury ◽  
Anal Sphincter Injury

Introduction This study aimed to ascertain whether missed obstetric anal sphincter injury at delivery had worse functional and quality of life outcomes than primary repair immediately following delivery. Materials and methods Two to one propensity matching was undertaken of patients presenting to a tertiary pelvic floor unit with ultrasound evidence of missed obstetric anal sphincter injury within 24 months of delivery with patients who underwent primary repair at the time of delivery by parity, grade of injury and time to assessment. Outcomes compared included Birmingham Bowel, Bladder and Urinary Symptom Questionnaire (BBUSQ), Wexner Incontinence Score, Short Form-36, Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire and anorectal physiology results. Results Thirty-two missed anal sphincter injuries were matched two to one with sixty-two patients who underwent primary repair of an anal sphincter defect. Mean time to follow-up was 9.31 ± 6.79 months. Patients with a missed anal sphincter injury had suffered more incontinence, as seen in higher the Birmingham Bowel, Bladder and Urinary Symptom Questionnaire (BBUSQ; 30.56% ± 14.41% vs. 19.75% ± 15.65%, P = 0.002) and Wexner scores (6.00 ± 3.76 vs. 3.67 ± 4.06, P = 0.009). They also had a worse BBUSQ urinary domain score (28.25% ± 14.9% vs. 17.01 ± 13.87%, P = 0.001) and worse physical functioning as measured by the Short Form-36 questionnaire (P = 0.045). There were no differences in other outcomes compared, including anorectal physiology and sexual function. Discussion In the short-term, patients with a missed obstetric anal sphincter injury had significantly worse faecal incontinence and urinary function scores, however quality of life and sexual function were largely comparable between groups. Conclusions Longer-term follow-up is needed to assess the effects of missed obstetric anal sphincter injury over time.

Factors predicting a failed primary repair of obstetric anal sphincter injury

2016 ◽  
Vol 95 (9) ◽  
pp. 1063-1069 ◽  
Author(s):  
Jaan Kirss ◽  
Tarja Pinta ◽  
Camilla Böckelman ◽  
Mikael Victorzon
Keyword(s):  
Anal Sphincter ◽  
Primary Repair ◽  
Obstetric Anal Sphincter Injury ◽  
Sphincter Injury ◽  
Anal Sphincter Injury

Primary repair of obstetric anal sphincter laceration: A randomized trial of two surgical techniques

2005 ◽  
Vol 192 (5) ◽  
pp. 1697-1701 ◽  
Author(s):  
Victoria Garcia ◽  
Rebecca G. Rogers ◽  
Suzy S. Kim ◽  
Rebecca J. Hall ◽  
Dorothy N. Kammerer-Doak
Keyword(s):  
Randomized Trial ◽  
Anal Sphincter ◽  
Primary Repair ◽  
Surgical Techniques ◽  
Anal Sphincter Laceration ◽  
Sphincter Laceration

Anal sphincter function and integrity after primary repair of third‐degree tear: uncontrolled prospective analysis

2004 ◽  
Vol 74 (3) ◽  
pp. 122-124 ◽  
Author(s):  
Nicholas Rieger ◽  
Shevy Perera ◽  
Jacque Stephens ◽  
Donna Coates ◽  
Darren Po
Keyword(s):  
Anal Sphincter ◽  
Primary Repair ◽  
Prospective Analysis ◽  
Sphincter Function ◽  
Anal Sphincter Function

scholarly journals Evaluation of Fistulotomy with Immediate Sphincteric Reconstruction in the Treatment of High Transsphincteric Perianal Fistula

2021 ◽  
Vol 41 (03) ◽  
pp. 217-221
Author(s):  
Yasser A. Orban ◽  
Hossam Hassan Soliman ◽  
Ahmed M. El Teliti ◽  
Ali El-Shewy ◽  
Yasmine Hany Hegab ◽  
...  
Keyword(s):  
Fistulous Tract ◽  
Perianal Fistula ◽  
Complete Healing ◽  
University Hospital ◽  
Direct Access ◽  
Fistula Tract ◽  
Recurrence Rates ◽  
Fistula Treatment ◽  
High Perianal Fistula ◽  
Sphincteric Reconstruction

Abstract Background High perianal fistula treatment remains challenging, mainly due to the variability in success and recurrence rates as well as continence impairment risks. So far, no procedure can be considered the gold standard for surgical treatment. Yet, strong efforts to identify effective and complication-free surgical options are ongoing. Fistulotomy can be considered the best perianal fistula treatment option, providing a perfect surgical field view, allowing direct access to the source of chronic inflammation. Controversy exists concerning the risk of continence impairment associated with fistulotomy. The present study aimed to assess the outcomes of fistulotomy with immediate sphincteric reconstruction regaring fistula recurrence, incontinence, and patient satisfaction. Methods This interventional study was performed at the General Surgery Department of Zagazig University Hospital during the period from July 2018 to December 2019 on 24 patients with a clinical diagnosis of high transsphincteric fistula-in-ano. The fistulous tract was laid open over the probe placed in the tract. After the fistula tract had been laid open, the tract was curetted and examined for secondary extensions. Then, suturing muscles to muscles, including the internal and external sphincters, by transverse mattress sutures. Results Our study showed that 2 patients develop incontinence to flatus ∼ 8.3%.and only one patient develop incontinence to loose stool, 4.2%. Complete healing was achieved in 83% and recurrence was 16.6%. Conclusion Fistulotomy with immediate sphincteric reconstruction is considered to be an effective option in the management of high perianal fistula, with low morbidity and high healing rate with acceptable continence state.

scholarly journals Study the Role of Loose versus cutting of Seton in Treatment of High Perianal fistula in a District Hospital of Health Insurance

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M S Abdelhameed ◽  
I M H Elghazawy ◽  
E A Elsayed
Keyword(s):  
Anal Fistula ◽  
Low Cost ◽  
Perianal Fistula ◽  
Dentate Line ◽  
Internal Opening ◽  
Fistula In Ano ◽  
One Year ◽  
Definition Of ◽  
A Prospective Study ◽  
High Perianal Fistula

Abstract When the track reaches the skin or another epithelialized surface then a fistula is formed. Anal fistula were classified on the basis of its relationship to the sphincters. The definition of high or low describes the height of the track as it traverses the sphincter muscles and not the position of the internal opening which is almost without exception at the dentate line. More accurately according to parks classification fistula in ano can result in an abscess between the internal and external sphincters, which in turn can spread to other parts of the perianal region. Infection can then track in many directions from this focus in the intersphincteric plane. Background Anal fistula is an abnormal communicative small channel that has an internal opening and an external opening and connected by the primary track. Our study evaluate the effectiveness of seton in high variety anal fistula. Objectives Evaluation the efficacy and safety of seton as surgical management of high anal fistula. Methods: This is a prospective study done on 30 patients in ELNile hospital in one Year period with high variety of anal fistula which is above the dentate line and were treated with seton .Outcome measured during follow up period were- successfully healed, recurrence, incontinence, percentage of complications and patients satisfaction. Result Among 30 patients mean age was 42.2+_6.8 years. Overall outcome of the patients showed-fistula completely healed in 27 patients, incontinence occurred in 3 patients and recurrence occurred in 3 patients. Conclusion Seton is relatively safe, effective and low cost for the management of high anal fistula with low rate of incontinence. It can therefore, be recommended as the standard of treatment for high variety fistula in ano.

scholarly journals Sphincter damage during fistulotomy for perianal fistulae and its relationship with faecal incontinence

2021 ◽  
Author(s):  
Stephanie García-Botello ◽  
Marina Garcés-Albir ◽  
Alejandro Espi-Macías ◽  
David Moro-Valdezate ◽  
Vicente Pla-Martí ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Anal Sphincter ◽  
Faecal Incontinence ◽  
External Anal Sphincter ◽  
Perianal Fistula ◽  
Anal Continence ◽  
Significant Deterioration ◽  
Perianal Fistulae

Abstract Background The length of sphincter which can be divided during fistulotomy for perianal fistula is unclear. The aim was to quantify sphincter damage during fistulotomy and determine the relationship between such damage with symptoms and severity of faecal incontinence and long-term quality of life (QOL). Methods A prospective cohort study was performed over a 2-year period. Patients with intersphincteric and mid to low transsphincteric perianal fistulas without risk factors for faecal incontinence were scheduled for fistulotomy. All patients underwent 3D endoanal ultrasound (3D-EAUS) pre-operatively and 8 weeks postoperatively. Measurements were taken of pre- and postoperative anal sphincter involvement and division. Anal continence was assessed using the Jorge-Wexner scale and QOL scores pre, 6 and 12 months postoperatively. Results Forty-nine patients were selected. A strong correlation between pre- and postoperative measurements was found p < 0.001. A median length of 41% of the external anal sphincter and 32% of the internal anal sphincter was divided during fistulotomy. Significant differences in mild symptoms of anal continence were found with increasing length of external anal sphincter division. But there was no significant deterioration in continence, soiling, or quality of life scores at the 1-year follow-up. Division of over two-thirds of the external anal sphincter was associated with the highest incontinence rates. Conclusions 3D-EAUS is a valuable tool for quantifying the extent of sphincter involvement pre- and postoperatively. Post-fistulotomy faecal incontinence is mild and increases with increasing length of sphincter division but does not affect long-term quality of life.

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