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Fistulectomy with primary sphincter reconstruction in the treatment of high transsphincteric anal fistulas

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

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.

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Acknowledgments

The author’s would like to thank Dr. Valesco Mann who performed the statistical calculation in this paper.

Funding source

University Giessen

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Authors and Affiliations

  1. Department of General, Visceral, Thoracic, Transplantation- and Pediatric Surgery, University Hospital Giessen, Rudolf-Buchheimstreet 7, 35395, Giessen, Germany

    Markus Hirschburger, Thilo Schwandner, Andreas Hecker & Winfried Padberg

  2. Coloproctology Center, Enddarmzentrum (EDZ) Mittelhessen, Neue Mitte 6, 35415, Giessen-Pohlheim, Germany

    Walter Kierer

  3. Praxisklinik Marburg, Im Rudent 2, 35043, Marburg, Germany

    Rolf Weinel

  4. Department of General Allgemein-, Viszeral-, Thorax- und Transplantationschirurgie, Uniklinikum Gießen, Rudolf-Buchheimstreet 7, 35385, Giessen, Germany

    Thilo Schwandner

Authors
  1. Markus Hirschburger
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  2. Thilo Schwandner
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  3. Andreas Hecker
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  4. Walter Kierer
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  5. Rolf Weinel
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  6. Winfried Padberg
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Corresponding author

Correspondence to Thilo Schwandner.

Additional information

All authors contributed to the study conception, design, collection of data, interpretation of data, and writing and revision of the manuscript.

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Hirschburger, M., Schwandner, T., Hecker, A. et al. Fistulectomy with primary sphincter reconstruction in the treatment of high transsphincteric anal fistulas. Int J Colorectal Dis 29, 247–252 (2014). https://doi.org/10.1007/s00384-013-1788-4

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  • DOI: https://doi.org/10.1007/s00384-013-1788-4

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