Lessons learned from an audit of 1250 anal fistula patients operated at a single center:A retrospective review  

作　　者：Pankaj Garg Baljit Kaur Ankita Goyal Vipul D Yagnik Sushil Dawka Geetha R Menon 

机构地区：[1]Department of Colorectal Surgery,Garg Fistula Research Institute,Panchkula 134113,Haryana,India [2]Department of Colorectal Surgery,Indus International Hospital,Mohali 140201,Punjab,India [3]Department of Radiology,SSRD Magnetic Resonance Imaging Institute,Chandigarh 160011,Chandigarh,India [4]Department of Pathology,Gian Sagar Medical College and Hospital,Patiala 140601,Punjab,India [5]Department of Surgical Gastroenterology,Nishtha Surgical Hospital and Research Center,Patan 384265,Gujarat,India [6]Department of Surgery,SSR Medical College,Belle Rive 744101,Mauritius [7]Department of Statistics,Indian Council of Medical Research,New Delhi 110029,New Delhi,India

出　　处：《World Journal of Gastrointestinal Surgery》2021年第4期340-354,共15页世界胃肠外科杂志（英文版）（电子版）

摘　　要：BACKGROUND A complex anal fistula is a challenging disease to manage.AIM To review the experience and insights gained in treating a large cohort of patients at an exclusive fistula center.METHODS Anal fistulas operated on by a single surgeon over 14 years were analyzed.Preoperative magnetic resonance imaging was done in all patients.Four procedures were performed:fistulotomy;two novel sphincter-saving procedures,proximal superficial cauterization of the internal opening and regular emptying and curettage of fistula tracts(PERFACT)and transanal opening of intersphincteric space(TROPIS),and anal fistula plug.PERFACT was initiated before TROPIS.As per the institutional GFRI algorithm,fistulotomy was done in simple fistulas,and TROPIS was done in complex fistulas.Fistulas with associated abscesses were treated by definitive surgery.Incontinence was evaluated objectively by Vaizey incontinence scores.RESULTS A total of 1351 anal fistula operations were performed in 1250 patients.The overall fistula healing rate was 19.4%in anal fistula plug(n=56),50.3%in PERFACT(n=175),86%in TROPIS(n=408),and 98.6%in fistulotomy(n=611)patients.Continence did not change significantly after surgery in any group.As per the new algorithm,1019 patients were operated with either the fistulotomy or TROPIS procedure.The overall success rate was 93.5%in those patients.In a subgroup analysis,the overall healing rate in supralevator,horseshoe,and fistulas with an associated abscess was 82%,85.8%,and 90.6%,respectively.The 90.6%healing rate in fistulas with an associated abscess was comparable to that of fistulas with no abscess(94.5%,P=0.057,not significant).CONCLUSION Fistulotomy had a high 98.6%healing rate in simple fistulas without deterioration of continence if the patient selection was done judiciously.The sphincter-sparing procedure,TROPIS,was safe,with a satisfactory 86%healing rate for complex fistulas.This is the largest anal fistula series to date.

关 键 词：Anal fistula FISTULOTOMY INCONTINENCE SURGERY RECURRENCE 

分 类 号：R657.1[医药卫生—外科学]