Fistulotomy with Primary Sphincter Repair in High Anal Fistula

Abstract

nal fistula is a common perianal condition associated with considerable morbidity and effect on patient’s quality of life. The main target of treatment of high anal fistula is to eradicate suppurative process and to prevent anal incontinence and recurrence which are the main challenge of fistula surgery. Several methods of treatment developed to cure the fistula without causing incontinence like seton, fistulotomy and sphincter sparing procedure. The aim of our study is to do fistulotomy with primary sphincter repair with assessment of recurrence rate, incontinence rate and patient satisfaction according to pain score, wound healing, discharge and return to daily activity parameters. This was prospective cohort study on 30 patients of high peri-anal fistulae and fistulotomy and reconstruction (primary suture repair) of anal sphincter was done., the patients were followed up 6 months postoperatively regarding their continence using Wexner score, recurrence, discharge and their return to work by scheduled outpatient clinical examination. Among 30 patients only three patients complaining usual incontinence mostly as post defecation soiling. Three patients reported anal fistula recurrence: One occurred at the 5th month, while the other two occurred at the 6th month after surgery. The procedure was well tolerated by the patients as most of them complaining only minimal pain and returned to work after two weeks without need of other stage like other procedures.