Abstract
Purpose
The purpose of this study was to assess the influence of identification of the location of the internal opening of anal fistula on the recurrence rate after surgical treatment in patients with primary transsphincteric anal fistulas. The influence of preoperative rectal ultrasound on the treatment results was studied.
Methods
One hundred thirty-one patients operated in the period February 1992 to July 2005 were analyzed. Endorectal ultrasound (ERUS) was not performed (till February 2004) on 103 out of the 131 patients, while the other 28 received ERUS (from March 2004). We performed either cutting seton technique or fistulectomy according to the course of fistulous tract (high or low transsphincteric fistulas). The recurrence rate of anal fistula was assessed after the complete healing of the anal fistula after 6 months.
Results
In patients in whom ERUS was not performed, the internal opening was identified by endoscopy in 41.7% and in 47.6% intraoperatively. In patients in whom ERUS was preoperatively performed, the internal opening was identified in 85.8%. In all the studied groups, the internal opening of anal fistula was not localized in 13 patients (9.9%). Recurrence of the fistulas occurred in ten patients (7.6%); in seven out of 13 patients, the internal opening was not found (53.85%), and in three out of 118, the internal opening was identified (2.54%).
Conclusions
Relative risk of anal fistula recurrence was 20-fold higher in patients in whom the internal opening was not identified than in those with the internal opening identified. Preoperative ERUS doubled the identification rate and thus decreased the risk of recurrence.
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References
Westerterp M, Volkers NA, Poolman RW, van Tets WF (2003) Anal fistulotomy between Skylla and Charybdis. Colorectal Dis 5:549–551
Dong W, Tetsuo Y, Junichi I (2002) Long-term results and quality of life outcomes in patients with transsphincteric fistulas after muscle-filling procedure. Dis Colon Rectum 45:1011–1015
Sygut A, Dziki A (2004) Modern diagnostics and treatment of anal fistulas. Pol Przegl Chir 76:1194–1208
Garcia-Aguilar J, Davey CS, Le CT, Lowry AC, Rothenberger DA (2000) Patient satisfaction after surgical treatment for fistula-in-ano. Dis Colon Rectum 43:1206–1212
Malouf AJ, Buchanan GN, Carapeti EA, Rao S, Guy RJ, Westcott E, Thomson JPS, Cohen CRG (2002) A prospective audit of fistula-in-ano at St. Mark's Hospital. Colorectal Disease 4:13–19
Joy HA, Williams JG (2002) The outcome of surgery for complex anal fistula. Colorectal Dis 4:254–261
Buchanan GN, Halligan S, Bartram CI, Williams AB, Tarroni D, Cohen CR (2004) Clinical examination, endosonography and MR imaging in preoperative assessment of fistula in ano: comparison with outcome-based reference standard. Radiology 233:674–681
Sainio P (1984) Fistula in ano in a defined population. Incidence and epidemiological aspects. Ann Chir Gynaecol 73:219–223
Dziki A, Bartos M, Sygut A (1996) Evaluation of therapeutic results in anal fistulas. Pol Przegl Chir 68:803–811
Dziki A, Bartos M (1998) Seton treatment of anal fistula: experience with a new modification. Eur J Surg 164:543–548
Dwarkasing S, Hussain SM, Krestin GP (2005) Magnetic resonance imaging of perianal fistulas. Semin Ultrasound CT MR 26:247–258
Ratto C, Grillo E, Parello A, Costamagna G, Doglietto GB (2005) Endoanal ultrasound—guided surgery for anal fistula. Endoscopy 37:722–728
West RL, Zimmerman DD, Dwarkasing S, Hussian SM, Hop WC, Schouten WR, Kuipers EJ, Felt-Bersma RJ (2003) Prospective comparison of hydrogen peroxide-enhanced three-dimensional endoanal ultrasonography and endoanal magnetic resonance imaging of perianal fistulas. Dis Colon Rectum 46:1407–1415
Pascual Miguelanez I, Garcia-Olmo D, Martinez-Puente MC, Pascual-Montero JA (2005) Is routine endoanal ultrasound useful in anal fistulas? Rev Esp Enferm Dig 97:323–327
Nicholls RJ (1996) Clinical assessment. In: Phillips RKS, Lunniss PJ (eds) Anal fistula: surgical evaluation and management. Chapman & Hall, London, pp 47–51
Garcia-Aguilar J, Belmonte C, Wong WD, Goldberg SM, Madoff RD (1996) Anal fistula surgery: factors associated with recurrence and incontinence. Dis Colon Rectum 39:723–729
Tang CL, Chew SP, Seow-Choen F (1996) Prospective randomized trial of drainage alone vs. drainage and fistulotomy for acute perianal abscessus with proven internal opening. Dis Colon Rectum 39:1415–1417
Sudoł-Szopińska I, Szczepkowski M, Panorska AK, Szopiński T, Jakubowski W (2004) Comparison of contrast-enhanced with non contrast endosonography in the diagnostics of anal fistulas. Eur Radiol 14:2236–2241
Buchanan GN, Bartram CI, Williams AB, Halligan S, Cohen CR (2005) Value of hydrogen peroxide enhancement of three-dimensional endoanal ultrasound in fistula in ano. Dis Colon Rectum 48:141–147
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Sygut, A., Mik, M., Trzcinski, R. et al. How the location of the internal opening of anal fistulas affect the treatment results of primary transsphincteric fistulas. Langenbecks Arch Surg 395, 1055–1059 (2010). https://doi.org/10.1007/s00423-009-0562-0
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DOI: https://doi.org/10.1007/s00423-009-0562-0