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This study aimed to compare the surgical outcomes of coring out fistulectomy with the closure of internal sphincter opening versus lay open fistulotomy (modified LIFT) and lay open fistulotomy and primary sphincter repair in trans-sphincteric perianal fistula
Fistula-in-ano is a common medical problem affecting thousands of patients annually. Symptoms generally affect quality of life significantly, and they range from minor discomfort and drainage with resultant hygienic problems to sepsis. Different classifications have been put forward which categorize these Fistula into low or high simple or complex, or according to their anatomy inter-sphincteric, trans-sphincteric, and supra- sphincteric or extra-sphincteric.
Conventional laying-open technique in high perianal fistula may involve sacrifice of part or whole of the sphincter muscle impairing continence. A transposition technique for the management of high anal and anorectal fistulae is described by Mann and Clifton in 1985. The method involves re-routing the extrasphincteric portion of the track into an intersphincteric position with immediate repair of the external sphincter.
Coring-out fistulectomy is a type of sphincter-preserving procedure that enables accurate resection of the fistula tract alone and thus reduces the possibility of missing a secondary tract
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Coring out Fistulectomy with Closure of Internal Sphincter Opening | Experimental | Patients underwent coring out fistulectomy with closure of internal sphincter opening |
|
| Lay Open Fistulotomy and Primary Sphincter Repair | Experimental | Patients underwent lay open fistulotomy and primary sphincter repair |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Coring out Fistulectomy with Closure of Internal Sphincter Opening | Procedure | The patient was laid in the lithotomy position. Skin preparation and draping were done. Normal saline irrigation was performed. The anal canal was sufficiently dilated to permit the introduction of a self-retaining retractor. With H2O2 injection into the fistula tract, the internal opening and tract of the fistula will be identified. The incision was made around the external opening, and the tract was all cored out along the tract from the external opening to the internal sphincter. Meticulous hemostasis will be performed, stay suture by PDS 4/0 around fistiolous opening at the internal sphincter, excision of fistulous tract above stay suture, then closure of internal sphincter defect by PDS 3/0. Anal packing with 4 × 4 epinephrine gauze and sterile protective dressing was performed. After the operation, a stool softener and pain controller were prescribed, and patients were discharged. |
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of recurrence of perianal fistula | Incidence of recurrence of perianal fistula was recorded and confirmed when an anal fistula or abscess is observed on any previously healed wound for 3 months. | 3 months postoperatively |
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of stool incontinence | Incidence of stool incontinence was recorded for 3 months. | 3 months postoperatively |
| Healing time | Healing was defined as cicatrization of all wounds without discharge at 3 months |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ain Shams University | Cairo | 11591 | Egypt |
The data will be available upon a reasonable request from the corresponding author after the end of study for one year.
After the end of study for one year.
The data will be available upon a reasonable request from the corresponding author.
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| Lay Open Fistulotomy and Primary Sphincter Repair | Procedure | Patients were put in a lithotomy position and the skin was then draped. After identification of the external fistula orifice probing of the fistula tract with identification of the fistulous tract and internal orifice with H2O2 injection into the fistula tract. The fistula was laid open and fistulectomy was then conducted and dissected with diathermy cautery help. Then Primary repair of the sphincter with PDS 3/0 with proper hemostasis using coagulation diathermy. |
|
| 3 months postoperatively |
| Length of hospital stay | Length of hospital stay was recorded from admission till discharge from hospital. | 1 week postoperatively |
| Complications | Complications such as (blood loss, pain, bleeding, discharge, urinary retention, urgency, wound infection) were recorded. | 3 months postoperatively |