Ann Surg Treat Res.  2022 Mar;102(3):167-175. 10.4174/astr.2022.102.3.167.

Coring-out fistulectomy for perianal cryptoglandular fistula: a retrospective cohort study on 20 years of experience at a single center

• Lee Ky
• Lee J
• Han EC
• Kwon YH
• Ryoo SB
• Park KJ

• KMID: 2526938
• DOI: http://doi.org/10.4174/astr.2022.102.3.167

Abstract

Purpose
Cryptoglandular fistula is one of the common anal diseases requiring surgical treatment. Various surgical techniques have been introduced; however, there is no known standard technique. Coring-out fistulectomy is a surgical technique that accurately resects only the fistula tract. However, only a few cases of this procedure have been reported. We aimed to analyze the surgical outcomes of coring-out fistulectomy for cryptoglandular anal fistulas.
Methods
We retrospectively reviewed the medical records of patients who underwent coring-out fistulectomy for a cryptoglandular fistula between 1999 and 2019. Primary outcomes were the treatment success rate (recurrence and healing rates) and incidence of fecal incontinence.
Results
A total of 184 patients were included in our study. The average age of the patients was 44 years (range, 16–75 years), and 88.0% were male. Twenty-four (13.0%), 13 (7.1%), and 68 patients (37.0%) underwent operation for recurrent fistula, multiple tracts, and complex type fistula, respectively. The healing rate was 92.4%, and recurrence occurred in 15 of 170 healed patients (8.8%). Thus, the treatment success rate was 84.2%. There was no fecal incontinence except in 1 patient who had preoperative fecal incontinence because of cauda equine syndrome. In multivariable analysis of the factors affecting the treatment success rate, the complex fistula (odds ratio [OR], 14.2; 95% confidence interval [CI], 4.7– 43.0; P < 0.001) and undetected internal opening during the operation (OR, 4.0; 95% CI, 1.4–11.6; P = 0.012) were significant factors.
Conclusion
Coring-out fistulectomy is a simple and feasible technique for sphincter-preserving anal fistula surgery.

Keyword

Anal fistula; Coring-out fistulectomy; Incontinence; Recurrence; Surgery

Figure

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  Fig. 1 Photographs of the anal fistula before, during, and after coring-out fistulectomy. (A) Preoperative findings. White arrow indicates external opening of the fistula. (B) Hydrogen peroxide is injected into the fistula to identify the tract and the internal opening of the fistula. (C) Marsupialization is performed with absorbable threads after coring-out fistulectomy. (D) Postoperative findings (1 month after the operation).

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  Fig. 2 Flow chart for management of a recurrent fistula.I&D, incision and drainage.

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  Fig. 3 Flow chart for management of a nonhealing fistula.

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