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Sfinkter koruyucu intersfinkterik fistül trakt ligasyon yöntemi ile standart fistülotomi yönteminin perianal fistül tedavisinde etkinliği: Karşılaştırmalı bir çalışma / Comparison of lift and fistulotomy in treatment of perianal fistula: Prospective randomized study

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Date
2014
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YARDIMCI, Erkan
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Bezmialem Vakıf University
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Abstract
Objective: Ligation of intersphincteric fistula tract is a relatively new method for treatment of perianal fistula. It is defined as ligation and cutting the fistula tract while protecting the sphincters in the intersphincteric field. The aim of this study is to compare the standard fistulotomy with the LIFT about the surgical activity and the effect on anal incontinence. Patients and methods: The records of 30 patients (18 male, 12 female, male/female: 3/2, age range: 24-72, mean age: 42.7), who are planned an operation for intersphincteric or low transsphincteric perianal fistula between December 2012 and April 2014 in Bezmialem Vakıf University General Surgery Clinic, devided into two equal groups. Patients older than 18 years of age with primary perianal fistula were included in the study. Patients with inflammatory bowel disease, gastrointestinal malignancy, granulomatous disease and tuberculosis were excluded. Standard fistulotomy is performed for the first group and LIFT is performed for the second group. The duration of follow-up is 4-19 months (mean 12,3 months) for the standard fistulotomy group and 4-21 months (mean 14,9 months) for the LIFT group. Preoperative anorectal endosonography (EUS) and/or MRI and physical examination are used for determine the type of fistula. 25 of the patients in this study was intersphincteric, 5 was low transsphincteric fistula. There was 13 intersphincteric, 2 transsphincteric fistula in standard fistulotomy group and 12 intersphincteric, 3 transsphincteric fistula in LIFT group. Anal incontinence is evaluated with anorectal manometry and Wexner clinic scoring system preoperative period and postoperative third month. Period of wound healing, enfection of wound and the rate of recurrence is compared. Results: There were no intraoperative complications. Although two recurrences (%13.4) developed in LIFT group, in standard fistulotomy group there was recurrence. Wound infection detected in one (%6.6) and two patients (%13.4) in standard fistulotomy and LIFT groups, respectively. Anal incontinance developed in one patient (%6.6) in standard fistulotomy group. In standard fistulotomy group the mean preoperative Wexner score was 1.00 ±1.13 and the postoperative third month score was 1.87 ±1.77. In LIFT group the mean preoperative Wexner score was 0.53 ±0.74 and the postoperative third month score was 0.60 ±0.63. There was no significant difference between the preoperative and postoperative Wexner scores (Preoperative Wexner p: 0.275, Postoperative Wexner p: 0.072). The mean wound healing was 27.4 ±2.77 days in standard fistulotomy group and 14.87 ±1.13 days in LIFT group. The period of wound healing was significantly low in LIFT group (p <0.001). There was no significant difference between the preoperative and postoperative MIP and MSP scores which was determined with anal manometry in two groups (p >0.05). Conclusions: In uncomplicated perianal fıstulas, LIFT technique has similar success rate as standard fistulotomy and both have similar recurrence rates. Standard fistulotomy causes an additional increase in Wexner clinic scores in patients with higher preoperative scores. In the LIFT group, the wound healing time is approximately 50% shorter than that of standard fistulotomy group.
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Thesis (Medical)--Bezmialem Vakıf University, Faculty of Medicine, Department of General Surgery, Istanbul, 2014.
Keywords
Genel Cerrahi = General Surgery, Genel Cerrahi Anabilim Dalı, Department of General Surgery, Anal kanal = Anal canal, Sfinkterotomi = Sphincterotomy
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