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Anorectal Fistula Surgery: Sphincter Sparing Operations

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Complications of Anorectal Surgery

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Abstract

Fistulotomy remains the most commonly performed operation to treat anal fistula. It has remained the most popular choice for decades primarily due to the high rate of successful fistula closure. Healing rates are commonly documented to be greater than 90–95%. In addition, fistulotomy is technically straightforward to perform, does not require specialized instrumentation, and is usually performed on an outpatient basis. However, fistulotomy is widely recognized to cause postoperative fecal incontinence. There are many risk factors, which have been associated with fecal incontinence including Crohn’s disease, HIV, diabetes, obstetric injuries, chronic diarrhea, multiple fistulas, etc. Perhaps most importantly, the anatomy of the fistula itself influences the risk of postoperative incontinence. Clearly the amount of sphincter divided by a fistulotomy will influence postoperative function. However, this relationship is neither direct nor predictable. There are no firm guidelines regarding the amount of sphincter that is safe to divide in a particular patient. Intersphincteric and low transsphincteric fistulas are generally safe to treat with simple fistulotomy, however, higher transsphincteric, suprasphincteric, and extrasphincteric fistulas present a risk for postoperative incontinence due to the quantity of sphincter muscle divided with fistulotomy.

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  1. Division of Colon and Rectal Surgery, Rush University Medical Center, 1725 W. Harrison Street, Suite 1138, Chicago, IL, 60612, USA

    Marc Singer

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  1. Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, Illinois, USA

    Herand Abcarian

  2. Division of Colon and Rectal Surgery, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, USA

    Jose Cintron

  3. Epidemiology/Biometry Division, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA

    Richard Nelson

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Singer, M. (2017). Anorectal Fistula Surgery: Sphincter Sparing Operations. In: Abcarian, H., Cintron, J., Nelson, R. (eds) Complications of Anorectal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-48406-8_3

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