AI Article Synopsis

  • Fistulotomy is a widely used treatment for anal fistula, but there's a concern about it leading to incontinence; this study compares outcomes of patients who had fistulotomy with and without sphincteroplasty.* -
  • The research involved 152 patients; those who had sphincteroplasty (Group A) showed more complex fistulas but had similar healing rates and septic complications compared to those who didn't have the repair (Group B).* -
  • Both groups achieved comparable healing rates (over 90%) and had no increased risk of postoperative infections, suggesting that sphincteroplasty could be a viable option, warranting further studies to investigate long-term functional outcomes.*

Article Abstract

Purpose: Fistulotomy is considered the most effective treatment for anal fistula; however, it carries a risk of incontinence. Sphincteroplasty in the setting of fistulotomy is not standard practice due to concerns regarding healing and potential infectious complications. We aimed to compare the outcomes of patients who underwent fistulotomy with primary sphincteroplasty to those who did not undergo repair.

Methods: This was a retrospective review of consecutive patients who underwent fistulotomy for cryptoglandular anal fistula. All operations were performed by one colorectal surgeon. Sphincteroplasty was performed for patients perceived to be at higher risk for continence disturbance. The main outcome measures were the healing rate and postoperative septic complications.

Results: In total, 152 patients were analyzed. Group A (fistulotomy with sphincteroplasty) consisted of 45 patients and group B (fistulotomy alone) included 107 patients. Both groups were similar in age (P=0.16) and sex (P=0.20). Group A had higher proportions of multiple fistulas (26.7% vs. 6.5%, P<0.01) and complex fistulas (mid to high transsphincteric, 37.8% vs. 10.3%; P<0.01) than group B. The median follow-up time was 8 weeks. The overall healing rate was similar in both groups (93.3% vs. 90.6%, P=0.76). No significant difference between the 2 groups was noted in septic complications (6.7% vs. 3.7%, P=0.42).

Conclusion: Fistulotomy with primary sphincter repair demonstrated a comparable healing rate to fistulotomy alone, without an increased risk of postoperative septic complications. Further prospective randomized studies are needed to confirm these findings and to explore the functional outcomes of patients who undergo sphincteroplasty.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11362758PMC
http://dx.doi.org/10.3393/ac.2022.01144.0163DOI Listing

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