Anal manometry improves the outcome of surgery for fistula-in-ano |
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Authors: | Dr M Pescatori MD G Maria MD G Anastasio MD L Rinallo MD |
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Institution: | (1) Istituto di Clinica Chirurgica, Policlinico Gemelli, Largo A. Gemelli, 8, 00168, Rome, Italy |
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Abstract: | The aim of this prospective study is to investigate whether anal manometry is useful in orienting the surgical policy and
improving the clinical and functional results following surgery for fistula-inano. Anal manometry was performed preoperatively
and postoperatively in 96 patients. The results of surgery, in terms of both fecal soiling and recurrence rate, were analyzed
and compared with those of another group of 36 subjects. Some operative maneuvers, such as internal sphincterotomy, laying
open of the fistula with division of striated muscle, or use of a seton, were carried out according to the preoperative sphincter
pattern as shown by anal manometry in the first group. A standard procedure was followed in the control group. The recurrence
rate was 3 percent in the anal manometry group and 13 percent in the control group (P<0.01); postoperative soiling occurred in 14 percent of patients in the anal manometry group compared with 31 percent of patients
in the control group (P<0.001). The functional results in transsphincteric and suprasphincteric fistulas, which are usually considered at higher
risk for postoperative incontinence, were better in the anal manometry group, due to greater use of the seton. No increase
in recurrence rate was observed in these complex fistulas after anal manometry. Internal sphincterotomy led to a disordered
continence, mainly when associated with division of striated muscle; a significant decrease in resting tone from 56±22 to
47±50 and voluntary contraction from 114±30 to 85±28 mm Hg (mean ± S) was found after surgery in patients with soiling. In
conclusion, the routine use of anal manometry may be recommended in the management of patients with fistula-in-ano as it improves
the clinical and functional outcome of surgery.
Read at the XIIth Biennial Congress of the International Society of University Colon and Rectal Surgeons, Glasgow, Scotland,
July 10 to 14, 1988. |
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Keywords: | Anal fistula Recurrence Incontinence Anal manometry |
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