Factors affecting continence after fistulotomy for intersphincteric fistula-in-ano

Abstract

Fistulotomy produces a satisfactory outcome in terms of eradicating sepsis and preserving function in the vast majority of patients with intersphincteric fistula with intact sphincters. However, sphincter-preserving treatment may be advocated for patients with low preoperative voluntary contraction pressure or those who have undergone multiple drainage surgeries. Preoperative anal manometry is useful in determining the proper surgical procedure.

The Role of 3-Dimensional Anorectal Ultrasonography in the Assessment of Anterior Transsphincteric Fistula

“…Because of the high rate of continence disorders after fistulotomy, 22,28,29 methods of sphincter integrity preservation, such as fibrin glue and anal fistula plugs, should be considered in female patients presenting with anterior transsphincteric fistula with Ͼ50.0% EAS involvement. Three-dimensional anorectal ultrasonography was shown to be useful in the preoperative assessment of anterior transsphincteric fistulas by quantifying the length of muscle to be transected, thereby contributing to the choice of a safe treatment approach and to the reduction of the rate of postoperative continence disorders.…”

Loose Seton: A Misnomer of Cutting Seton

“…These results might be due to different variety of seton materials and techniques described or perianal fistula characteristics and reported outcomes in the literature. So far, there is no uniform method used to study the endpoints from one series to another [14] [15].…”

Controversies in Fistula in Ano

“…Fistulotomy or fistulectomy involves division of the underlying sphincter tissue & is generally recommended for low fistulas. However, sphincter-preserving treatment may be advocated for patients with low preoperative voluntary contraction pressure or those who have undergone multiple drainage surgeries [5]. Fistulectomy with primary sphincter reconstruction can improve both anal continence and manometric values in incontinent patients, without compromising them in fully continent ones [6].…”