Comparative Study between Fistulectomy and Cutting Seton in Treatment of high Perianal Fistulae

Abstract

The anal canal is the terminal portion of the large intestine. It is surrounded by strong muscles composed of the internal sphincter, the longitudinal muscle fibers, the external sphincter and the levator ani muscles. At the junction of the rectum and anal canal, a ring of muscles composed of the upper borders of the internal and external sphincter, and the puborectalis muscle is called the anorectal ring. This ring is of great importance as division of this ring during anorectal operations will inevitably result in anal incontinence. At the level of dentate line, the anal intermuscular glands open into the anal canal. It is related to certain potential spaces filled with connective tissue and liable to get infected. The incidence of anorectal suppuration is common during the third and fourth decade of life and much commoner in men than in women. Anal fistula is predominantly a disease of men and of middle age with male/female ratio roughly 5.1 with maximal incidence between the third and fifth decades. The first step in the pathogenesis of anal fistula is the formation of an intersphincter abscess in relation to the termination of an anal gland lying • between the internal sphincter and the longitudinal intersphincteric muscle fibers, subsequently the pus may force its way in any direction, this theory sounds logic as the internal opening in many cases of anal fistula, that open internally, is at an anal crypt.