Stapled Endorectal Mucosectomy for High Extrasphincteric Fistula-in-Ano: Preliminary Report |
| |
Authors: | Francisco Perez MD Antonio Arroyo PhD Fernando Candela PhD Rafael Calpena PhD |
| |
Institution: | (1) Coloproctology Unit, Department of Surgery, University Hospital of Elche, Elche, Spain;(2) C/General Bonanza 4, 4° B, Alicante, 03007, Spain |
| |
Abstract: | Purpose There is no optimum surgical method of repair for high extrasphincteric fistula-in-ano. We describe a relatively simple procedure
for surgery of extrasphincteric fistula, which entirely preserves the anal sphincter, does not interfere with anal function,
and does not preclude the possibility of further surgery, if necessary.
Methods Five patients have been treated for high extrasphincteric fistula with a stapled endorectal flap by using a circular hemorrhoidal
stapler gun. The procedure involved two 180° pursestrings placed above the dentate line and 3 cm apart, proximal and distal
to the internal opening. On firing, the result was the excision of a 180° rectal flap, containing the internal ostium, and
including rectal mucosa and submucosa.
Results No perioperative complications were encountered. There was some temporary difficulty in controlling flatus and/or defecatory
urgency in two patients, which spontaneously reversed with no treatment within the first two postoperative months. The mean
Cleveland Clinic Score of Incontinence did not vary significantly after surgery. Overall anal manometry did not register any
significant differences between preoperative and postoperative values. With up to 26 months of follow-up, none of the fistulas
recurred.
Conclusions These preliminary promising results suggest that the stapled endorectal flap could have a role in the management of high extrasphincteric
fistula-in-ano.
An erratum to this article is available at . |
| |
Keywords: | Extrasphincteric fistula-in-ano Complex fistula-in-ano Advancement flap Rectal mucosectomy |
本文献已被 PubMed SpringerLink 等数据库收录! |
|