Dados do Trabalho

Título

FISTULOTOMY AND PRIMARY END TO END SPHINCTEROPLASTY FOR CRYPTOGENIC ANAL FISTULA (F.I.P.S.).RESULTS AND LESSONS LEARNED.

Objetivo(s)

Objective: Recently, sphincter reconstruction after fistulectomy or fistulotomy was technically recognized as a stand-alone technique. Before, was technically forbidden, alleging various motivations (high wound dehiscence rates, high recurrence rate etc). We present here the results obtained in a 5 year retrospective study where fistulotomy and primary end-to-end sphincteroplasty with a modified technique were used to treat cryptogenic anal fistulas.

Método

Method: This is a retrospective study. All patients were operated by a single surgeon (UM), with the same technique, fistulotomy associated to a fine excision of fistula tract tissue and primary end to end sphincteroplasty (of IAS , EAS or both), and a small anal mucosal flap to close the internal fistulous opening. All patients had a diagnosis of intersphincteric, trans-sphincteric or suprasphincteric perianal fistulas (low,high and suprasphincteric fistulas were included in this study);all patients were submitted to a preoperative Pelvic MRI, anorectal manometry and colonoscopy. The Wexner Incontinence Score was calculated preoperatively and postoperatively for all patient. All were followed up as outpatients at 7 days ,1 month, 3 and 6 months after surgery.

Resultados

Results: 57 patients were studied, 42 males and 15 females, mean age 40,91 (19-68). 20 patients were diagnosed with intersphincteric fistulas, 36 with transphincteric, 1 supra-sphincteric (27 anterior and 30 posterior fistulas), with 26 complex fistulas and 31 single tract fistulas, 5 patients who presented recurrence and were previously operated by other surgeons. 2 patients related preoperative mild incontinence (resolved after surgery). Postoperative complications included 10 patients with delayed cicatrisation,1 postoperative (PO4) bleeding, 2 perianal dermatitis, 2 partial mucosal dehiscence with 1 patient needing mucosal resuturing ,1 anal profile deformity (resulting in a mild temporary fecal incontinence).2 patients (3,4%) had a total dehiscence needing re-operative management. No recurrences were observed during follow up.

Conclusão(ões)

Conclusion: Fistulotomy and primary end-to-end sphincteroplasty is a safe surgical strategy to treat anal fistulas with low complication rate.