Perianal fistula: retrospective study of surgical treatment of 241 cases

Abstract

Perianal fistula, usually has a criptoglandular etiology, developing from a perianal abscess and communicating the anal mucosa with the perianal skin. The aim of this paper is to study retrospectively 241 cases of perianal fistula (172 men and 69 women; 2,5:1) aging from 7 and 80 years old (average: 37,4 years), operated on at the Hospital da Clínicas - UFMG, from 1977 to 1996. The surgical techniques and post-operative outcome have been analysed. Perianal abscesses with spontaneous drainage were the predominant etiology (132 patients; 54,8%). Eighty percent were submitted to fistulectomy as the first surgical treatment. Among early complications (78; 32,4%), local pain was the most frequent (60; 24,9%). Among the late complications (136; 56,4%) fistula recurrence (101; 41,9%) was the most frequent. There were 141 reoperations in 80 patients. Fistulectomy was the predominant surgical technique employed for the treatment (101; 71,6%). The average hospitalization time was 6,3 days until 1990 and 1,5 day from 1991 to 1996, after the advent of day-surgery beds in HC-UFMG. The surgical treatment of perianal fístula has a significant rate of post-operative complications and a high recurrence rate, in spite of the short stay in hospital

Long‐term outcome of loose seton for complex anal fistula: a two‐centre study of patients with and without Crohn’s disease

“…The early postsurgical complication rates of bleeding and infection were in accordance with those reported in large series [7,11–13], being five (8%) for non‐CD and three (18%) for CD patients. The fistula recurred or persisted in nearly half (47%) of our non‐CD patients, which is higher than reported in large series with, for example, an overall recurrence rate ranging between 10 and 33% [13]. Recurrence is higher (41–44%) among patients with complex fistulae [9,13], which is very similar to the present study.…”

“…The fistula recurred or persisted in nearly half (47%) of our non‐CD patients, which is higher than reported in large series with, for example, an overall recurrence rate ranging between 10 and 33% [13]. Recurrence is higher (41–44%) among patients with complex fistulae [9,13], which is very similar to the present study. The rate of recurrence or persistence was high (40%) among CD patients, a figure that concurs with other large case series in the literature which report a range of 40–48% [7,11,14].…”

“…In a series of 59 patients, Drager et al. [13] found no significant difference in function or healing (92%) or recurrence rates between the two methods.…”

Efficacy of irrigation tubes in the management of para rectal cavities associated with complex fistula-in-ano

“…Perianal fistula usually have a criptoglandular aetiology and develop from perianal gland infection. Infection of anal glands is reported to occur in about 90% of the cases [ 1 ]. Sepsis then spreads in the inter-sphincteric plane and sometimes extends into other tracts as described by Parks, forming inter-sphincteric, trans-sphincteric, extra-sphincteric and supra-sphincteric fistula tracts [ 2 ].…”

“…Sepsis then spreads in the inter-sphincteric plane and sometimes extends into other tracts as described by Parks, forming inter-sphincteric, trans-sphincteric, extra-sphincteric and supra-sphincteric fistula tracts [ 2 ]. The majority of the fistula tracts (90–95%) are simple, which are characterized by an easily identifiable fistula tract [ 1 ]. On the contrary, complex fistulae can have multiple extensions and are occasionally associated with pararectal cavities.…”