Skip to main content

Advertisement

SpringerLink
Log in

Stapled Endorectal Mucosectomy for High Extrasphincteric Fistula-in-Ano: Preliminary Report

  • Technical Notes
  • Published:
Diseases of the Colon & Rectum

An Erratum to this article was published on 25 May 2006

Purpose

There is no optimum surgical method of repair for high extrasphincteric fistula-in-ano. We describe a relatively simple procedure for surgery of extrasphincteric fistula, which entirely preserves the anal sphincter, does not interfere with anal function, and does not preclude the possibility of further surgery, if necessary.

Methods

Five patients have been treated for high extrasphincteric fistula with a stapled endorectal flap by using a circular hemorrhoidal stapler gun. The procedure involved two 180° pursestrings placed above the dentate line and 3 cm apart, proximal and distal to the internal opening. On firing, the result was the excision of a 180° rectal flap, containing the internal ostium, and including rectal mucosa and submucosa.

Results

No perioperative complications were encountered. There was some temporary difficulty in controlling flatus and/or defecatory urgency in two patients, which spontaneously reversed with no treatment within the first two postoperative months. The mean Cleveland Clinic Score of Incontinence did not vary significantly after surgery. Overall anal manometry did not register any significant differences between preoperative and postoperative values. With up to 26 months of follow-up, none of the fistulas recurred.

Conclusions

These preliminary promising results suggest that the stapled endorectal flap could have a role in the management of high extrasphincteric fistula-in-ano.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. WR Schouten DD Zimmerman JW Briel (1999) ArticleTitleTransanal advancement flap repair of transsphincteric fistulas Dis Colon Rectum 42 1419–1423 Occurrence Handle10566529 Occurrence Handle1:STN:280:DC%2BD3c%2FjtVyjtw%3D%3D Occurrence Handle10.1007/BF02235039

    Article  PubMed  CAS  Google Scholar 

  2. SM Sentovich (2003) ArticleTitleFibrin glue for anal fistulas Dis Colon Rectum 46 498–502 Occurrence Handle12682544 Occurrence Handle10.1007/s10350-004-6589-y

    Article  PubMed  Google Scholar 

  3. O Zmora N Mizrahi N Rotholtz et al. (2003) ArticleTitleFibrin glue sealing in the treatment of perineal fistulas Dis Colon Rectum 46 584–589 Occurrence Handle12792432 Occurrence Handle10.1007/s10350-004-6612-3

    Article  PubMed  Google Scholar 

  4. JM Jorge SD Wexner (1993) ArticleTitleEtiology and management of fecal incontinence Dis Colon Rectum 36 77–97 Occurrence Handle8416784 Occurrence Handle1:STN:280:ByyC3crnsVw%3D Occurrence Handle10.1007/BF02050307

    Article  PubMed  CAS  Google Scholar 

  5. A Koelher A Risse-Schaaf S Athanasiadis (2004) ArticleTitleTreatment for horseshoe fistulas-in-ano with primary closure of the internal fistula opening: a clinical and manometric study Dis Colon Rectum 47 1874–1882 Occurrence Handle10.1007/s10350-004-0650-8

    Article  Google Scholar 

  6. PJ Lunniss RK Phillips (2000) Anal fistula: evaluation and management RK Phillips (Eds) Colorectal surgery WB Saunders London 261–288

    Google Scholar 

  7. N Mizrahi SD Wexner O Zmora et al. (2002) ArticleTitleEndorectal advancement flap. Are there predictors of failure? Dis Colon Rectum 45 1616–1621 Occurrence Handle12473884 Occurrence Handle10.1007/s10350-004-7248-z

    Article  PubMed  Google Scholar 

  8. G Ozuner TL Hull J Cartmill VW Fazio (1996) ArticleTitleLong-term analysis of the use of transanal rectal advancement flaps for complicated anorectal/vaginal fistulas Dis Colon Rectum 39 10–14 Occurrence Handle8601343 Occurrence Handle1:STN:280:BymC1c7jt1M%3D Occurrence Handle10.1007/BF02048261

    Article  PubMed  CAS  Google Scholar 

  9. F Makowiec EC Jehle HD Becker M Starlinger (1995) ArticleTitleClinical course after transanal flap repair of fistula in patients with Crohn's disease Br J Surg 82 603–606 Occurrence Handle7613925 Occurrence Handle1:STN:280:ByqA3sfms1A%3D

    PubMed  CAS  Google Scholar 

  10. S Athanasiadis C Helmes R Yazigi A Köhler (2004) ArticleTitleThe direct closure of the internal fistula opening without advancement flap for transsphincteric fistulas-in-ano Dis Colon Rectum 47 1174–1180 Occurrence Handle15148648 Occurrence Handle10.1007/s10350-004-0551-x

    Article  PubMed  Google Scholar 

  11. YH Ho C Tsang CL Tang D Nya KW Eu F Seow-Choen (2000) ArticleTitleAnal sphincter injuries from stapling instruments introduced transanally: randomized, controlled study with endoanal ultrasound and anorectal manometry Dis Colon Rectum 43 169–173 Occurrence Handle10696889 Occurrence Handle1:STN:280:DC%2BD3c7lvF2lsA%3D%3D Occurrence Handle10.1007/BF02236976

    Article  PubMed  CAS  Google Scholar 

  12. Perez-Vicente F, Arroyo A, Serrano P, Candela F, Sanchez A, Calpena R. Prospective randomized clinical trial of single versus double purse-string stapled mucosectomy in the treatment of prolapsed haemorrhoids. Int J Colorectal Dis 2005;21:38–43.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Coloproctology Unit, Department of Surgery, University Hospital of Elche, Elche, Spain

    Francisco Perez M.D., Antonio Arroyo Ph.D., Fernando Candela Ph.D. & Rafael Calpena Ph.D.

  2. C/General Bonanza 4, 4° B, Alicante, 03007, Spain

    Francisco Perez M.D.

Authors
  1. Francisco Perez M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Antonio Arroyo Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fernando Candela Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rafael Calpena Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Francisco Perez M.D..

Additional information

An erratum to this article is available at http://dx.doi.org/10.1007/s10350-006-0605-3.

About this article

Cite this article

Perez, F., Arroyo, A., Candela, F. et al. Stapled Endorectal Mucosectomy for High Extrasphincteric Fistula-in-Ano: Preliminary Report. Dis Colon Rectum 49, 519–523 (2006). https://doi.org/10.1007/s10350-005-0312-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10350-005-0312-5

Key words

Search

Navigation