Document Detail

Successful sphincter-sparing surgery for all anal fistulas.
MedLine Citation:
PMID:  17674105     Owner:  NLM     Status:  MEDLINE    
PURPOSE: This study was designed to evaluate the success of a sphincter-sparing treatment algorithm for patients with anal fistulas. METHODS: All patients with anal fistulas presenting to a single surgeon from 1999 to 2004 were retrospectively reviewed. Patients were treated according to a sphincter-sparing algorithm that utilized three operative approaches: subcutaneous fistulotomy, seton placement followed by fibrin glue, and/or seton placement followed by rectal advancement flap. Data analyzed included: age, gender, type of fistula, operative intervention, treatment success, and functional results. RESULTS: A total of 137 patients with anal fistulas were evaluated (age range, 23-74 years). Fistula etiology was cryptoglandular in 116 (85 percent), inflammatory bowel disease in 9 (7 percent), HIV in 3 (2 percent), and miscellaneous in 9 (7 percent). A subcutaneous fistulotomy was possible in 38 patients (28 percent), and all of these patients healed. The remaining 99 patients (72 percent) with transsphincteric fistulas underwent staged procedures: 89 patients (65 percent) underwent seton placement followed by fibrin glue closure (55 healed, 62 percent success rate), 9 patients had seton placement followed by flap (9 healed, 100 percent success rate), and 1 patient had seton placement alone. Of the 34 patients with fibrin glue failure, retreatment with glue was successful in 8 of 14 (57 percent success rate). The remaining 20 patients who declined glue retreatment and the 6 patients who failed glue retreatment underwent flap (26 healed, 100 percent success rate). All fistulas healed with an average of two operations per patient, and fecal continence was maintained in all patients. CONCLUSIONS: By using staged operative procedures without any division of anal sphincter muscle, all fistulas healed with excellent functional results. A sphincter-sparing approach can successfully treat all anal fistulas.
Kelly M Tyler; Cary B Aarons; Stephen M Sentovich
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Diseases of the colon and rectum     Volume:  50     ISSN:  0012-3706     ISO Abbreviation:  Dis. Colon Rectum     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-10-15     Completed Date:  2007-12-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372764     Medline TA:  Dis Colon Rectum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1535-9     Citation Subset:  IM    
Department of Surgery, Boston University School of Medicine, One Boston Medical Center Place, Boston, Massachusetts 02118, USA.
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MeSH Terms
Digestive System Surgical Procedures / methods*
Fibrin Tissue Adhesive / therapeutic use
Follow-Up Studies
Middle Aged
Rectal Fistula / etiology,  surgery*
Retrospective Studies
Surgical Flaps
Suture Techniques
Tissue Adhesives / therapeutic use
Treatment Outcome
Reg. No./Substance:
0/Fibrin Tissue Adhesive; 0/Tissue Adhesives

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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