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Anal Function after Ligation of the Intersphincteric Fistula Tract

Tsunoda, Akira M.D., Ph.D.; Sada, Haruki M.D.; Sugimoto, Takuya M.D.; Nagata, Hiroshi M.D.; Kano, Nobuyasu M.D., Ph.D.

Diseases of the Colon & Rectum: July 2013 - Volume 56 - Issue 7 - p 898–902
doi: 10.1097/DCR.0b013e31828d2e29
Original Contributions: Anorectal Disease
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BACKGROUND: Although the ligation of the intersphincteric fistula tract is a promising anal sphincter-saving procedure for fistula-in-ano, the objective assessment of the sphincter preservation remains unknown.

OBJECTIVE: The primary end point was to measure the anal function before and after this procedure. The secondary end point measured was cure of the disease.

DESIGN: This study is a prospective observational study.

SETTING: This study was conducted at the Department of Surgery, Kameda Medical Center, Japan, from March 2010 to August 2012.

PATIENTS: Twenty patients with transsphincteric or complex fistulas were evaluated.

INTERVENTIONS: All patients underwent the ligation of the intersphincteric fistula tract with a loose seton for anal fistulas.

MAIN OUTCOME MEASURES: Anal manometric study was performed before and 3 months after the procedure. Fecal incontinence was evaluated by using the fecal incontinence severity index. Failure was defined as nonhealing of the surgical wound or fistula.

RESULTS: The median operation time was 42 minutes. No intraoperative complications were documented. The median follow-up duration was 18 (3–32) months. No patients reported any incontinence postoperatively. The median score of the fecal incontinence severity index before and 3 months after the procedure was 0. The median maximum resting pressure measured before and after operation were 125 (71–175) cm H2O and 133 (95–169) cm H2O. The median maximum squeeze pressure measured before and after operation were 390 (170–815) cm H2O and 432 (200–902) cm H2O. There were no significant postoperative changes in either the resting pressure or the squeeze pressure. Primary healing was observed in 19 (95%) patients, and the median healing time was 7 weeks; 1 wound remained incompletely healed.

LIMITATIONS: Short-term follow-up may not justify the use of the term definitive cure.

CONCLUSION: The ligation of the intersphincteric fistula tract with a loose seton showed no postoperative deterioration on anal sphincter function with favorable healing rates.

Department of Surgery, Kameda Medical Center, Chiba, Japan

Funding/Support: This work was supported in part by the Kameda Medical Center Foundation for surgical research.

Financial Disclosure: None reported.

Podium presentation at the meeting of the International Society of University Colon & Rectal Surgeons, Bologna, Italy, June 24 to 26, 2012.

Correspondence: Akira Tsunoda, M.D., Ph.D., Department of Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba 296–8602 Japan. E-mail: a.tsunoda@kameda.jp

© 2013 The American Society of Colon and Rectal Surgeons