| Title |
Fistulectomy with primary sphincter reconstruction
|
|---|---|
| Published in |
International Journal of Colorectal Disease, April 2018
|
| DOI | 10.1007/s00384-018-3042-6 |
| Pubmed ID | |
| Authors |
Steffen Seyfried, Dieter Bussen, Andreas Joos, Christian Galata, Christel Weiss, Alexander Herold |
| Abstract |
Despite modern medical techniques, anatomically proximal (high) anal fistulas are still a challenge in colorectal surgery. In previous years, the standard of care was complete fistulectomy with a high rate of continence disorders. Over the past 20 to 30 years, sphincter-saving procedures have gained wide acceptance. They represent the technique used in these cases. Additionally, many patients received indefinite treatment, namely the placement of a seton to maintain surgical drainage. The main problem with all fistula surgical possibilities is the high recurrence rate of 30 to 50% in flap procedures and 100% persistence in seton treatments. In recent years, a direct repair (primary reconstruction) in distal fistulas was instigated and shows excellent results. It allowed our technique for proximal (high) anal fistulas to evolve. All patients who underwent surgery at the University Medical Center Mannheim, Department of Colo-proctology (from 06/2003 to 11/2015), were retrospectively evaluated using a prospective database. Patients who underwent fistulectomy with primary sphincter reconstruction were all included. The primary healing rate, after a mean follow-up of 11 months (7 to 200 months), was 88.2% (374 of 424). Taking into account revisionary surgeries with secondary sphincter repair, this rate reaches 95.8% (406 of 424). Factors such as gender and fistula location as related to the sphincter had significant influence on the study outcome, whereas variables such as the amount of reconstructed muscle (in mm), number of revisions, patient age, other anal operations, and concomitant medication did not. The incontinence of a subgroup of 148 patients was evaluated in detail by way of a questionnaire. Even at a preoperative baseline, 9.6% of those patients reported some minor degree of continence disorders. After the procedure, incontinence disorders were observed in 34 patients (23.0%), with 23 of these patients suffering from flatus incontinence (15.5%), 10 patients from liquid incontinence (6.8%), and 1 patient from solid fecal incontinence. Fistulectomy with primary sphincter reconstruction is a feasible procedure resulting in a low recurrence rate. No other procedure has shown better results in transsphincteric fistulas. Continence disorders seem to be of minor relevance/consequence for these patients. |
Mendeley readers
The data shown below were compiled from readership statistics for 55 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 55 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Other | 4 | 7% |
| Researcher | 4 | 7% |
| Student > Postgraduate | 4 | 7% |
| Student > Doctoral Student | 3 | 5% |
| Unspecified | 3 | 5% |
| Other | 11 | 20% |
| Unknown | 26 | 47% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 24 | 44% |
| Unspecified | 3 | 5% |
| Social Sciences | 1 | 2% |
| Agricultural and Biological Sciences | 1 | 2% |
| Unknown | 26 | 47% |
Attention Score in Context
This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 30 April 2018.
All research outputs
#15,508,366
of 23,047,237 outputs
Outputs from International Journal of Colorectal Disease
#1,053
of 1,844 outputs
Outputs of similar age
#209,850
of 329,226 outputs
Outputs of similar age from International Journal of Colorectal Disease
#28
of 45 outputs
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