One stage complex transphincteric anal fistula excision with reconstruction of anal sphincter without stool diversion / Salim Mohamed Abousharkh ; Supervised Ahmad Farag Ahmad Farag , Amr Alshayeb , Mohamed Yehia

Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of General Surgery

Aim of the study: To evaluate the role of One stage complex trans-sphincteric anal fistula excision with reconstruction of anal sphincter without stool diversion Methods: This was cohort study on fifty patients of complex trans-sphincteric anal fistulae with mean age of 38.5 years, the patients were subjected to fistulectomy and reconstruction (primary suture repir) of anal sphincter and without stool diversion. The patients were assessed 12 weeks postoperatively after complete healing of the wound and their continence postoperatively was assessed using Wexner and Farag score Results: Among those fifty patients only two of them had developed anal incontinence with varying degrees in which one female developed gas incontinence and another male developed soiling. The female patient responded after biofeedback therapy and gained continence. Three patients had recurrence (two of them had low branching anal fistula and one had high trans sphinteric fistula). Four patients had delayed wound healing in which one of them had nonspecific pathology, two hidradenitis suppurativa. It worth saying that the 2 Chron's patients and the nonspecific pathology patient are the same patients who developedrecurrence. Conclusion: So, it had been found that one stage surgery (fistulectomy with primary sphincter repair without stool diversion) has good results in healing the fistula with low risk of incontinence, lower recurrence rate and good wound healing results

Issued also as CD