Complicated horseshoe anal fistulas that involve deep postanal space, ischiorectal space, and pelvirectal space are difficult problems for a surgeon. In general there are two surgical methods for treating such fistulas. The first is a Hanley
operation,
a kind of fistulotomy. The second is muscle filling.
In the Hanley operation, the posterior portion of the subcutaneous external sphincter, super ficial external sphincer, and internal sphincter, and internal sphincter are severed, allowing the dead space to be filled with granulation tissue. The
muscle
filling method used a muscle flap to fill the dead space created by removal of the fistular tract. The muscle filling method has many advantages such as less sphincter muscle destruction, a lower incontinence rate, and a shorter wound healing
time.
For
that reason, e reviewed 110 cases of anal fistulas which were treated from Jan. 1993 to Dec. 1993. At Song Do Anorectal Hospital by the muscle filling method and which could be followed up.
@ES The results are as follows:
@EN 1) the male to female ratio was k15 : 1, and the most prevalent age groups were the 4th decade and the 5th decade(40%, 30%).
2) According to the Sumikoshi classification, ischiorectal fistulas occurred in 81 cases (74%) and pelvirectal fistulas in 29 cases(26%).
3) The 81 cases of ischiorectal fistulas were treated by the muscle filling method: 76 by the sliding method. 2 by the one-flap method, and 3 by the two-flap method. Twenty-threc of the 29 cases of pelvirectal fistulas were treated by the
sliding
method and 6 by the sliding method with gluteus maximus muscle filling.
4) The primary opening and the primary focus were all located at the posterior in the lithoto my position (6 o' clock).
5) According to the pathologic diagnosis, tuberculous fistulas were observed in 4 cases(3.6%).
6) The average wound-healing time was 40 days, shorter than previously reported healing times for the Hanley operation.
7) Before muscle filling was done at Song Do Anorectal Hospital, 50 patients (46%) had one previous operations, 25 patients (23%) two previous operations, and 9 patients (8%) more than three operations.
8) After the muscle filling at Song Do Anorectal Hospital, a fistula recurred in only 1 of the 110 cases (1%).
With the above results, the authors submit that muscle filling is the most effective operation method for treating complicated anal fistulas involving ischiorectal and pelvirectal space, especially because muscle filling has many advantages such
as
less
sphincter muscle destruction less anal deformity, a lower incontinence rate, and a lower recurrence rate.
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