International Journal of Colorectal Disease

, Volume 22, Issue 9, pp 1097–1102

Non-sphincter splitting fistulectomy vs conventional fistulotomy for high trans-sphincteric fistula-in-ano: a prospective functional and manometric study

  • Takayuki Toyonaga
  • Makoto Matsushima
  • Yoshiaki Tanaka
  • Kazunori Suzuki
  • Nobuhito Sogawa
  • Hiroki Kanyama
  • Yasuhiro Shimojima
  • Tomoaki Hatakeyama
  • Masao Tanaka
Original Article

DOI: 10.1007/s00384-007-0288-9

Cite this article as:
Toyonaga, T., Matsushima, M., Tanaka, Y. et al. Int J Colorectal Dis (2007) 22: 1097. doi:10.1007/s00384-007-0288-9

Abstract

Purpose

This study compared the clinical and physiological results of non-sphincter splitting fistulectomy (N-SSF) with those of sphincter splitting fistulotomy (SSF) for treatment of high trans-sphincteric fistula-in-ano.

Materials and methods

A prospective, observational study was undertaken in 70 consecutive patients with high trans-sphincteric fistula treated by SSF (n = 35) or N-SSF (n = 35). Anal manometry was performed before and 3 months after surgery. Anal continence was assessed using the Cleveland Clinic Florida Incontinence Score.

Results

There was no difference between the two groups in age, gender, presence of horseshoe extension, preoperative incontinence score and manometric values. The incidence of recurrence was similar between the two groups. The postoperative incontinence score of the SSF group was significantly higher than that of the N-SSF group (1.9 ± 2.9 vs 1.1 ± 2.9, P = 0.0347). Maximum resting pressure showed significant decrease after surgery in both groups (83.2 to 56.1 mmHg, P = 0.0001 and 85.1 to 58.4 mmHg, P = 0.0001). Voluntary contraction pressure and functional anal canal length did not change after N-SSF (137.6 to 138.2 mmHg, P = 0.9524 and 4.06 to 4.07 cm, P = 0.9524), but significantly decreased after SSF (120.2 to 96.7 mmHg, P = 0.0085 and 4.12 to 3.74 cm, P = 0.0183).

Conclusion

Non-sphincter splitting fistulectomy for high trans-sphincteric fistula provided better functional results than fistulotomy. Less impairment of anal continence was achieved possibly not only by maintenance of the external anal sphincter function but also by preservation of the length of the high-pressure zone.

Keywords

Trans-sphincteric fistula Anal incontinence Anal manometry Advancement flap Fistulotomy 

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Takayuki Toyonaga
    • 1
  • Makoto Matsushima
    • 1
  • Yoshiaki Tanaka
    • 1
  • Kazunori Suzuki
    • 1
  • Nobuhito Sogawa
    • 1
  • Hiroki Kanyama
    • 1
  • Yasuhiro Shimojima
    • 1
  • Tomoaki Hatakeyama
    • 1
  • Masao Tanaka
    • 2
  1. 1.Department of SurgeryMatsushima Hospital Colo-Proctology CenterYokohamaJapan
  2. 2.Department of Surgery and Oncology, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan