Retrospective Analysis of a Fistula-in-ano: Focus on an Anal-sphincter-preserving Procedure

Han, Ki Su; Cho, Hyeon Min; Kim, Do Hyoung; Kim, Jun Gi

Abstract

PURPOSE: The results of anal fistula treatments have improved with the development of the anal fistula operative technique. However, there are still complications, such as recurrence and anal incontinence. To this end, the authors classified anal fistulas by using Sumikoshi's classification and performed an anal-sphincter-preserving procedure.
METHODS
We experienced 98 anal fistula cases involving 86 patients who underwent anal fistula operations at The Catholic University of Korea, St. Vincent's Hospital from January 2001 to December 2006. This study was done retrospectively by chart review and telephone questioning. The follow-up period was from 2 to 72 months (mean 29.5, SD: 19.1).
RESULTS
The study showed 0 cases of Type I (0.0%), 49 cases of Type II (50.0%), 46 cases of Type III (46.9%), and 3 cases of Type IV (3.1%) fistulas. Among the 98 fistula-in-ano operations were 27 (27.6%) of fistulotomies and 71 (72.4%) sphincter-preserving procedures (2 cases of coring-out+muscle filling+rectal mucosal advancement flap, 31 cases of coring-out+ muscle closure+rectal mucosal advancement flap, 28 cases of coring-out+cutting seton, and 10 cases of loose seton). After the sphincter-preserving operation, there were 4 cases (4/71, 5.6%) of recurrence. There were no major disorders of the anal sphincter. However, minor disorders of the anal sphincter (6/71, 8.5%, soiling) were found.
CONCLUSIONS
The anal-sphincter-preserving procedure is very effective in preventing recurrence and anal incontinence, but these results are from a retrospective study with a small number of patients and the follow-up period was short. If further cases are collected and continuous follow-up is done, better results can be expected.