Abstract
Despite modern surgical techniques, anal fistulas are still a challenge in colorectal surgery. In former years, the standard of care was complete fistulectomy with a high rate of continence disorders. Over the past 20–30 years, sphincter-saving procedures have gained wide acceptance. They represent the technique used in these cases. Also, many patients stayed with a long-term seton as definite treatment. The main problem of all surgical possibilities is a high recurrence rate with 30–50% in flap procedures and 100% of persistence in seton treatments. In recent years we started to do a direct repair (primary reconstruction) in distal fistulas with excellent results and evolved our technique for proximal (high) anal fistulas. Our results demonstrated that fistulectomy with primary sphincter reconstruction is a safe and feasible procedure for both distal and intermediate transsphincteric fistulas alike, showing higher rates of healing than other procedures. Even in proximal (high) transsphincteric and suprasphincteric fistulas, the procedure shows comparable healing rates compared to other procedures. Continence disorders are of minor relevance and consequence for these patients.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Arroyo A, Pérez-Legaz J, Moya P et al (2012) Fistulotomy and sphincter reconstruction in the treatment of complex fistula-in-ano: long-term clinical and manometric results. Ann Surg 255:935–939. https://doi.org/10.1097/SLA.0b013e31824e9112
Christiansen J, Rønholt C (1995) Treatment of recurrent high anal fistula by total excision and primary sphincter reconstruction. Int J Colorectal Dis 10:207–209
De Hous N, Van den Broeck T, de Gheldere C. Fistulectomy and primary sphincteroplasty (FIPS) to prevent keyhole deformlty in simple anal fistula: a single-center retrospective cohort study. Acta Chirurgica Belgica. https://doi.org/10.1080/00015458.2020.1753151
Gemsenjäger E (1996) Results with a new therapy concept in anal fistula: suture of the anal sphincter. Schweiz Med Wochenschr 126(47):2021–2025
Herold A (2014) Fistulectomy with primary sphincter reconstruction. In: Abcarian H (ed) Anal fistula: principles and management. Springer, New York. https://doi.org/10.1007/978-1-4614-9014-2_10
Herold A (2019) Fistulektomie und primäre Sphinkterrekonstruktion. Coloproctology 41:267–271. https://doi.org/10.1007/s00053-019-0365-x
Herold A, Joos A, Hellmann U, Bussen D (2009) Treatment of high anal fistula: is fistulectomy with primary sphincter repair an option? Colorectal Dis 11:15
Hirschburger M, Schwandner T, Hecker A et al (2014) Fistulectomy with primary sphincter reconstruction in the treatment of high transsphincteric anal fistulas. Int J Colorectal Dis 29:247–252. https://doi.org/10.1007/s00384-013-1788-4
Lewis A (1996) Anal fistula. In: Phillips RKS, Lunniss PJ (eds) Surgical evaluation and management. Chapman and Hall, London, pp 81–86
Lux N, Athanasiadis S (1991) Functional results following fistulectomy with primary muscle suture in high anal fistula. A prospective clinical and manometric study. Chirurg 62:36–41
Ommer A, Herold A, Berg E et al (2011) Cryptoglandular anal fistulas. Dtsch Arztebl Int 108:707–713. https://doi.org/10.3238/arztebl.2011.0707
Parkash S, Lakshmiratan V, Gajendran V (1985) Fistula-in-ano: treatment by fistulectomy, primary closure and reconstitution. Aust N Z J Surg 55(1):23–27
Parks AG, Gordon PH, Hardcastle JD (1976) A classification of fistula-in-ano. Br J Surg 63:1–12
Perez F, Arroyo A, Serrano P et al (2006) Randomized clinical and manometric study of advancement flap versus fistulotomy with sphincter reconstruction in the management of complex fistula-in-ano. Am J Surg 192:34–40. https://doi.org/10.1016/j.amjsurg.2006.01.028
Ratto C, Litta F, Donisi L, Parello A (2015) Fistulotomy or fistulectomy and primary sphincteroplasty for anal fistula (FIPS): a systematic review. Tech Coloproctol 19:391–400. https://doi.org/10.1007/s10151-015-1323-4
Ritchie R, Sackier J, Hodde J (2009) Incontinence rates after cutting seton treatment for anal fistula. Colorectal Dis 11:564–571
Roig JV, Garcia-Armengol J et al (1999) Immediate reconstruction of the anal sphincter after fistulectomy in the management of complex anal fistulas. Colorectal Dis 1:137–140. https://doi.org/10.1046/j.1463-1318.1999.00021-x
Seyfried S, Bussen D, Joos A, Galata C, Weiss C, Herold A (2018) Fistulectomy with primary sphincter reconstruction. Int J Colorectal Dis 33:911–918. https://doi.org/10.1007/s00384-018-3042-6
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Section Editor information
Rights and permissions
Copyright information
© 2022 Springer Nature Switzerland AG
About this entry
Cite this entry
Herold, A. (2022). Utility of Adding Sphincter Reconstruction to Fistulotomy/Fistulectomy. In: Ratto, C., Parello, A., Litta, F., De Simone, V., Campennì, P. (eds) Anal Fistula and Abscess. Coloproctology. Springer, Cham. https://doi.org/10.1007/978-3-030-76670-2_21
Download citation
DOI: https://doi.org/10.1007/978-3-030-76670-2_21
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-76669-6
Online ISBN: 978-3-030-76670-2
eBook Packages: MedicineReference Module Medicine