Is a Lateral Internal Sphincterotomy Necessary after Fistulotomy in a Fissure–Fistula Complex?
Background: Fissure–fistula complex is a poorly described condition involving patients with chronic anal fissure and associated fistula-in-ano. Currently, there are no published guidelines on the surgical management of this problem. Objective: The aim of this study was to help establish guidelines f...
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| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2021-01-01
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| Series: | World Journal of Colorectal Surgery |
| Subjects: | |
| Online Access: | https://journals.lww.com/10.4103/WJCS.WJCS_5_21 |
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| Summary: | Background:
Fissure–fistula complex is a poorly described condition involving patients with chronic anal fissure and associated fistula-in-ano. Currently, there are no published guidelines on the surgical management of this problem.
Objective:
The aim of this study was to help establish guidelines for the surgical management of patients with fissure–fistula complex.
Design:
The study was designed as a retrospective cohort study.
Setting:
Data were obtained from the operative reports and medical records of patients from two colorectal surgery practices in southeast Michigan from 2000 to 2019.
Patients and Methods:
Forty-nine patients (47% female, 53% male) with fissure–fistula complexes were included for data analysis. The average age was 45 years. A total of 45 patients (92%) had no previous anorectal surgery, 45 (92%) had a posterior fissure complex, 26 (53%) had an intersphincteric fistula, and 23 (47%) had a low transsphincteric fistula. Although this was a retrospective study, data were described for outcomes of patients who received only a simple fistulotomy as a treatment for fissure–fistula complex.
Main Outcome Measures:
The primary outcome was the necessity of a lateral internal sphincterotomy after fistulotomy for resolution of the fissure.
Sample Size:
Forty-nine patients.
Results:
Three patients (6%) required repeat fistulotomy or abscess drainage during the follow-up period, and only one patient (2%) required a lateral sphincterotomy to resolve the chronic fissure. Forty-five patients (98%) healed their fissures after fistulotomy without sphincterotomy (95% confidence interval [89.1, 99.9]).
Conclusions:
Our study demonstrated that there is no likely need for a lateral internal sphincterotomy in addition to a fistulotomy in patients with a fissure–fistula complex for resolution of the chronic fissure. Clinical guidelines for the management of this condition should highlight primary fistulotomy as the standard treatment of fissure–fistula complex.
Limitations:
This study was limited by its retrospective nature and small sample size.
Conflict of Interest:
None. |
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| ISSN: | 1941-8213 |