Die Fistulotomie

Purpose

The optimal treatment for high/complex anal fistulas remains unclear. We studied one surgeon??s results over a 10-year period, concentrating on high fistulas.

Methods

Demographic, fistula anatomy and treatment data were recorded for all patients undergoing surgery for anal fistula. Outcome data were recorded for patients who had been followed-up for a minimum of 4?weeks.

Results

In all, 180?patients were studied. Outcome data were available for 52 low and 84 high fistulas. Fistulotomy was performed for 50 low and 48 high fistulas, with closure rates of 98% and 96%, respectively. Fistula recurrence was seen in two patients with high fistulas. Symptoms of sphincter disturbance were similar after lay open of both low and high fistulas. The treatment of high fistulas by drainage seton had a lower rate of inadvertent passage of flatus but a similar rate of minor soiling compared with fistulotomy.

Conclusions

Lay open of low and high anal fistulas is effective and associated with a similar, predictable rate of minor sphincter disturbance, affecting a third to a quarter of patients with mild leakage of flatus and mucus. Patients with high fistulas can be cured; however, in case of doubt, a second opinion should be sought from an expert centre before definitive intervention.