Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

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.

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

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

IBD:

Inflammatory bowel disease

POD:

Post-operative day

EUS:

Evaluation under sedation

References

  1. Malik A, Hall D, Devaney R et al (2011) The impact of specialist experience in the surgical management of perianal abscess. Int J Surg 9:475–477

    Article  PubMed  Google Scholar 

  2. Hippocrates (1886) The genuine works of Hippocrates. Translated from the Greek with a preliminary discourse and annotations by Francis Adams. New York 2: 251

  3. Milligan ETC, Morgan CN (1934) Surgical anatomy of the anal canal with special reference to anorectal fistulae. Lancet 2

  4. Tabry H, Farrands PA (2011) Update on anal fistulae: surgical prospectives for the gastroenterologist. Can J Gastroenterol 25:675–680

    Article  PubMed  PubMed Central  Google Scholar 

  5. Pironi D, Caruso F, Panarese A et al (2010) Chronic hidradenitis suppurativa in the inguinal, perineal and scrotal regions. A case report and review of the literature. Ann Ital Chir 81:465–470

    PubMed  Google Scholar 

  6. Blumetti J, Abcarian A, Quinteros F et al (2012) Evolution of treatment of fistula in ano. World J Surg 36:1162–1167

    Article  CAS  PubMed  Google Scholar 

  7. Eisenhammer S (1956) The internal anal sphincter and the anorectal abscess. Surg Gynecol Obstet 103:501–506

    CAS  PubMed  Google Scholar 

  8. Shrum RC (1959) Anorectal pathology in 1000 consecutive patients with suspected surgical disorders. Dis Colon Rectum 2:469–472

    Article  CAS  PubMed  Google Scholar 

  9. Beaulieu R, Bonekamp D, Sandone C et al (2013) Fistula in ano: when to cut, tie, plug, or sew. J Gastrointest Surg 17:1143–1152

    Article  PubMed  Google Scholar 

  10. Nelson RL (2002) Anorectal abscess fistula: what do we know? Surg Clin North Am 82:1139–1151

    Article  PubMed  Google Scholar 

  11. Ramanujam PS, Prasad ML, Abcarian H et al (1984) Perianal abscesses and fistulas. A study of 1023 patients. Dis Colon Rectum 27:593–597

    Article  CAS  PubMed  Google Scholar 

  12. Raslan SM, Aladwani M, Alsanea N (2016) Evaluation of the cutting seton as a method of treatment for perianal fistula. Ann Saudi Med 36:210–215

    PubMed  Google Scholar 

  13. Mascagni D, Naldini G, Stuto A et al (2015) Recurrence after stapled haemorrhoidopexy. Tech Coloproctol 19:321–322

    Article  CAS  PubMed  Google Scholar 

  14. Pironi D, Panarese A, Vendettuoli M et al (2013) Chronic radiation-induced proctitis: the 4% formalin application as non-surgical treatment. Int J Colorectal Dis 28:261–266

    Article  PubMed  Google Scholar 

  15. Panarese A, Pironi D, Vendettuoli M et al (2012) Stapled and conventional Milligan-Morgan haemorrhoidectomy: different solutions for different targets. Int J Colorectal Dis 27:483–487

    Article  PubMed  Google Scholar 

  16. Cirocchi R, Trastulli S, Morelli U et al (2012) The treatment of anal fistulas with biologically derived products: is innovation better than conventional surgical treatment? An update. Tech Coloproctol 17:259–273

    Article  PubMed  Google Scholar 

  17. Liu WY, Aboulian A, Kaji AH et al (2013) Long-term results of ligation of intersphincteric fistula tract (LIFT) for fistula-in-ano. Dis Colon Rectum 56:343–347

    Article  PubMed  Google Scholar 

  18. Binda GA, Piscitelli A, Longhin R (2012) Treatment of higt ano-vaginal fistula with GORE BIO-A(®) fistula plug in an immunocompromised patient. Tech Coloproctol 17:609–611

    Article  PubMed  Google Scholar 

  19. Sileri P, Boehm G, Franceschilli L et al (2012) Collagen matrix injection combined with flap repair for complex anal fistula. Colorectal Dis 14:24–28

    Article  PubMed  Google Scholar 

  20. Parks AG (1976) A classification of fistula-in-ano. Br J Surg 63:1–12

    Article  CAS  PubMed  Google Scholar 

  21. Parks AG (1961) Pathogenesis and treatment of fistula-in-ano. Br Med J 1:463–469

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Malik AI, Nelson RL, Tou S (2010) Incision and drainage of perirectal abscess with or without treatment of anal fistula. Cochrane Database Syst Rev 7: CD006827

  23. Kontovounisios C, Tekkis P, Tan E et al (2016) Adoption and success rates of perineal procedures for fistula-in-ano: a systematic review. Colorectal Dis 18:441–458

    Article  CAS  PubMed  Google Scholar 

  24. Toyonaga T, Matsushima M, Tanaka Y et al (2007) Microbiological analysis and endoanal ultrasonography for diagnosis of anal fistula in acute anorectal sepsis. Int J Colorectal Dis 22:209–213

    Article  PubMed  Google Scholar 

  25. Siddiqui MR et al (2012) A diagnostic accuracy meta-analysis of endoanal ultrasound and MRI for perianal fistula assessment. Dis Colon Rectum 55:576–585

    Article  PubMed  Google Scholar 

  26. Fucini C, Giani I (2011) Why do we have to review our experience in managing cases with idiopatic fistula-in-ano regurarly? World J Gastroenterol 17:3297–3299

    Article  PubMed  PubMed Central  Google Scholar 

  27. Jacob TJ, Perakath B, Keighley MR (2010) Surgical intervention for anorectal fistula. Cochrane Database Syst Rev 5: CD006319

  28. O’Riordan JM, Datta I, Johnston C et al (2012) A systematic review of the anal fistula plug for patients with Crohn’s and non-Crohn’s related fistula-in-ano. Dis Colon Rectum 55:351–358

    Article  PubMed  Google Scholar 

  29. Ratto C, Litta F, Donisi L et al (2015) Fistulotomy or fistulectomy and primary sphincteroplasty for anal fistula (FIPS): a systematic review. Tech Coloproctol 19:391–400

    Article  CAS  PubMed  Google Scholar 

  30. O’Riordan JM, Baxter NN (2013) The management of fistula-in-ano: a plea for randomized trials and standard reporting of case series with adequate follow-up. Dis Colon Rectum 56:e1. doi:10.1097/DCR.0b013e318274219c

    Article  PubMed  Google Scholar 

  31. Pontone S, Pironi D, Pontone P et al (2011) Combined approach for the treatment of anorectal condyloma. Carbon dioxide laser excision and endoscopic argon plasma coagulation in a case report. Ann Ital Chir 82:159–162

    PubMed  Google Scholar 

  32. Garcia-Aguilar J, Belmonte C, Wong WD et al (1993) Anal fistula surgery. Factors associated with recurrence and incontinence. Dis Colon Rectum 39:723–729

    Article  Google Scholar 

  33. West RL, Zimmerman DD, Dwarkasing S et al (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

    Article  CAS  PubMed  Google Scholar 

  34. Lockart-Mummery JP (1947) Treatment of fistula in ano. Lancet 1:671

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgical Sciences, Sapienza University, Rome, Italy

    Domenico Mascagni, Daniele Pironi, Stefano Pontone, Maya Tonda, Chiara Eberspacher, Alessandra Panarese, Giandomenico Miscusi, Gianmarco Grimaldi, Antonio Catania, Alberto Santoro, Angelo Filippini & Salvatore Sorrenti

Authors
  1. Domenico Mascagni
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniele Pironi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stefano Pontone
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maya Tonda
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chiara Eberspacher
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alessandra Panarese
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Giandomenico Miscusi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Gianmarco Grimaldi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Antonio Catania
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Alberto Santoro
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Angelo Filippini
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Salvatore Sorrenti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniele Pironi.

Ethics declarations

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.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mascagni, D., Pironi, D., Pontone, S. et al. Total fistulectomy, sphincteroplasty and closure of the residual cavity for trans-sphincteric perianal fistula in the elderly patient. Aging Clin Exp Res 29 (Suppl 1), 101–108 (2017). https://doi.org/10.1007/s40520-016-0652-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40520-016-0652-0

Keywords

Search

Navigation