Abstract
Eleven patients with infra-levator trans-sphincteric fistula-in-ano underwent fistula excision with rectal flap advancement. The clinical results were assessed by interview and the physiological function determined by ano-rectal manometry. Nine patients underwent paired studies before and 5 (range 2 to 6) months after operation. Median maximum resting anal pressure was 84 (48–135) cm water before operation and 76 (29–139) cm water after operation (P=N.S.). Median maximum squeeze pressure was 112 (64–290) cm water before operation and 88 (44–316) cm water after operation (P=N.S.). The median sphincter length was preserved after operation. There was one clinical failure following the development of an abscess under the flap. All patients are continent and there have been no recurrences. We conclude that rectal flap advancement is an acceptable way to cure more complex fistula-in-ano. Good functional results are achieved by maintaining anal sphincter function together with preservation of the integrity of the anal margin.
Résumé
Onze patients porteurs d'une fistule anale infralévatorienne transsphinctérienne ont subi l'excision du trajet fistuleux et le confection d'un lambeau muqueux d'avancement. Les résultats cliniques ont été évalués par des interviews et la fonction physiologique déterminée par une manométrie ano-rectale. Neuf patients ont subi les examens avant et 5 mois (de 2 à 6) après l'opération. La presion de repos moyenne maximale était de 84 (48–135) cm d'eau avant l'opération et 76 (29–138) cm d'eau après l'opération (P=N.S.). La pression maximale de contraction volontaire était de 112 (64–290) cm d'eau avant l'opération et 88 (44–316) cm d'eau après l'opération (P=N.S.). La longueur moyenne du sphincter était préservée après l'opération. Un échec clinique est à déplorer résultant du développement d'une abcés sous le lambeau. Tous les patients sont continents et il n'y a aucune évidence de récidive. Nous concluons que la technique de lambeau muqueux est une modalité thérapeutique acceptable dans le traitement de fistula anale complexe. De bons résultats fonctionnels peuvent être obtenus en préservant la fonction sphinctérienne et en maintenant l'intégrité de la marge anale.
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Lewis, W.G., Finan, P.J., Holdsworth, P.J. et al. Clinical results and manometric studies after rectal flap advancement for infra-levator trans-sphincteric fistula-in-ano. Int J Colorect Dis 10, 189–192 (1995). https://doi.org/10.1007/BF00346216
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DOI: https://doi.org/10.1007/BF00346216