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Aging Clinical and Experimental Research

, Volume 29, Supplement 1, pp 101–108 | Cite as

Total fistulectomy, sphincteroplasty and closure of the residual cavity for trans-sphincteric perianal fistula in the elderly patient

  • Domenico Mascagni
  • Daniele Pironi
  • Stefano Pontone
  • Maya Tonda
  • Chiara Eberspacher
  • Alessandra Panarese
  • Giandomenico Miscusi
  • Gianmarco Grimaldi
  • Antonio Catania
  • Alberto Santoro
  • Angelo Filippini
  • Salvatore Sorrenti
Original Article
  • 97 Downloads

Abstract

Background

Perianal fistula is a complex and frequent disease. At present, no treatment nor technique has shown an absolute superiority in terms of efficacy and recurrence rate. The technique has to be chosen considering the balance between faecal continence preservation and disease eradication. Rarely concomitant perianal abscess and fistula are treated at the same time, and often time to complete recovery is long.

Aims

The aim of this study was to evaluate the possibility of treating the abscess and the fistula tract in one procedure with total fistulectomy, sphincteroplasty and an almost complete closure of the residual cavity, thus reducing the healing time in older patients.

Methods

A non-randomized single-centre series of 86 patients from 2007 to 2012 with low–medium trans-sphincteric perianal fistula (< 30% of external sphincter involvement) with or without synchronous perianal abscess were treated with total fistulectomy, sphincteroplasty and closure of the residual cavity technique.

Results

Success rate was 97.7% with a healing time of 4 weeks; overall morbidity was 16.2%; recurrence rate was 2.3%; no major alterations of continence were observed.

Discussion

Fistulectomy, sphincteroplasty and closure of the residual cavity are associated with a low rate of recurrence and good faecal continence preservation in older patients. This technique can be safely used even with a concomitant perianal abscess, with reduction in healing time and in the number of surgical procedures needed.

Conclusions

Total fistulectomy with sphincteroplasty and partial closure of the residual cavity, as described, is a safe procedure but has to be performed by dedicated colorectal surgeons.

Keywords

Fistulectomy Perianal fistula Sphincteroplasty Trans-sphincteric fistula Geriatric surgery 

Abbreviations

IBD

Inflammatory bowel disease

POD

Post-operative day

EUS

Evaluation under sedation

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

“For this type of study formal consent is not required”.

Statement of human and animal rights

This article does not contain any studies with animals performed by any of the authors.

Informed consent

All patients gave their consent to the processing of sensitive data and the therapeutic treatment.

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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Domenico Mascagni
    • 1
  • Daniele Pironi
    • 1
  • Stefano Pontone
    • 1
  • Maya Tonda
    • 1
  • Chiara Eberspacher
    • 1
  • Alessandra Panarese
    • 1
  • Giandomenico Miscusi
    • 1
  • Gianmarco Grimaldi
    • 1
  • Antonio Catania
    • 1
  • Alberto Santoro
    • 1
  • Angelo Filippini
    • 1
  • Salvatore Sorrenti
    • 1
  1. 1.Department of Surgical SciencesSapienza UniversityRomeItaly

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