Outcomes of surgery for high transsphincteric anal fistulas: prospective randomized trial
Background. Reliable data on the efficacy and safety of fistulectomy with primary sphincter repair for the treatment of high transsphincteric anal fistulas are deficient.The aim. To compare the efficacy and safety of fistulectomy with advancement muco-muscular flap (F) and fistulectomy with primary...
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| Language: | Russian |
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Scientific Сentre for Family Health and Human Reproduction Problems
2023-07-01
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| Series: | Acta Biomedica Scientifica |
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| Online Access: | https://www.actabiomedica.ru/jour/article/view/4227 |
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| author | Yu. A. Churina D. D. Shlyk R. T. Rzayev V. V. Balaban P. V. Tsarkov |
| author_facet | Yu. A. Churina D. D. Shlyk R. T. Rzayev V. V. Balaban P. V. Tsarkov |
| author_sort | Yu. A. Churina |
| collection | DOAJ |
| description | Background. Reliable data on the efficacy and safety of fistulectomy with primary sphincter repair for the treatment of high transsphincteric anal fistulas are deficient.The aim. To compare the efficacy and safety of fistulectomy with advancement muco-muscular flap (F) and fistulectomy with primary sphincter reconstruction (SR) for the treatment of high anorectal fistulas.Methods. A cohort of 92 consecutive patients with transsphincteric anal fistula involving 1/3 to 2/3 of the sphincteric complex were included in prospective randomized study. The primary endpoint was the recurrence rate. The duration of surgery, blood loss, pain intensity, postoperative complications, the duration of wound healing, incontinence, quality of life were registered.Results. Forty-six patients were randomized in each group. A statistically significant difference was obtained for operative time (Group “F” – 45 (20–160) min, Group “SR” – 33 (10–55) min). The blood loss was 3 (1–20) and 2 (1–10) ml in Groups “F” and “SR”, respectively (p = 0.482). The return to work in Groups “SR” and “F” occurred after 7 (2–14) and 8 (4–20) days, respectively (p = 0.005). The pain syndrome was significantly greater in Group “F” (p < 0.05) on days 1 and 7. Recurrence rate was in 23.9 % (11 cases) in Group “F” and in 6.5 % (3 cases) in Group “SR” (p = 0.042). Incontinence was in 7 (15.2 %) people in Group “F”, in 10 patients (21.7 %) – in Group “SR” (p = 0.591). There was no statistically significant difference in postoperative complications.Conclusion. Findings can expand the indications for the treatment of high transsphincteric anorectal fistulas involving from 1/3 to 2/3 of the sphincter complex without statistically significant risk for functional results. |
| format | Article |
| id | doaj-art-52f5e6807ebe44af8e6a6341a1cbd732 |
| institution | Kabale University |
| issn | 2541-9420 2587-9596 |
| language | Russian |
| publishDate | 2023-07-01 |
| publisher | Scientific Сentre for Family Health and Human Reproduction Problems |
| record_format | Article |
| series | Acta Biomedica Scientifica |
| spelling | doaj-art-52f5e6807ebe44af8e6a6341a1cbd7322025-08-20T03:56:53ZrusScientific Сentre for Family Health and Human Reproduction ProblemsActa Biomedica Scientifica2541-94202587-95962023-07-018319020010.29413/ABS.2023-8.3.212594Outcomes of surgery for high transsphincteric anal fistulas: prospective randomized trialYu. A. Churina0D. D. Shlyk1R. T. Rzayev2V. V. Balaban3P. V. Tsarkov4I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)Background. Reliable data on the efficacy and safety of fistulectomy with primary sphincter repair for the treatment of high transsphincteric anal fistulas are deficient.The aim. To compare the efficacy and safety of fistulectomy with advancement muco-muscular flap (F) and fistulectomy with primary sphincter reconstruction (SR) for the treatment of high anorectal fistulas.Methods. A cohort of 92 consecutive patients with transsphincteric anal fistula involving 1/3 to 2/3 of the sphincteric complex were included in prospective randomized study. The primary endpoint was the recurrence rate. The duration of surgery, blood loss, pain intensity, postoperative complications, the duration of wound healing, incontinence, quality of life were registered.Results. Forty-six patients were randomized in each group. A statistically significant difference was obtained for operative time (Group “F” – 45 (20–160) min, Group “SR” – 33 (10–55) min). The blood loss was 3 (1–20) and 2 (1–10) ml in Groups “F” and “SR”, respectively (p = 0.482). The return to work in Groups “SR” and “F” occurred after 7 (2–14) and 8 (4–20) days, respectively (p = 0.005). The pain syndrome was significantly greater in Group “F” (p < 0.05) on days 1 and 7. Recurrence rate was in 23.9 % (11 cases) in Group “F” and in 6.5 % (3 cases) in Group “SR” (p = 0.042). Incontinence was in 7 (15.2 %) people in Group “F”, in 10 patients (21.7 %) – in Group “SR” (p = 0.591). There was no statistically significant difference in postoperative complications.Conclusion. Findings can expand the indications for the treatment of high transsphincteric anorectal fistulas involving from 1/3 to 2/3 of the sphincter complex without statistically significant risk for functional results.https://www.actabiomedica.ru/jour/article/view/4227fecal incontinencefistulasurgical flapsrecurrencemagnetic resonance imaging |
| spellingShingle | Yu. A. Churina D. D. Shlyk R. T. Rzayev V. V. Balaban P. V. Tsarkov Outcomes of surgery for high transsphincteric anal fistulas: prospective randomized trial Acta Biomedica Scientifica fecal incontinence fistula surgical flaps recurrence magnetic resonance imaging |
| title | Outcomes of surgery for high transsphincteric anal fistulas: prospective randomized trial |
| title_full | Outcomes of surgery for high transsphincteric anal fistulas: prospective randomized trial |
| title_fullStr | Outcomes of surgery for high transsphincteric anal fistulas: prospective randomized trial |
| title_full_unstemmed | Outcomes of surgery for high transsphincteric anal fistulas: prospective randomized trial |
| title_short | Outcomes of surgery for high transsphincteric anal fistulas: prospective randomized trial |
| title_sort | outcomes of surgery for high transsphincteric anal fistulas prospective randomized trial |
| topic | fecal incontinence fistula surgical flaps recurrence magnetic resonance imaging |
| url | https://www.actabiomedica.ru/jour/article/view/4227 |
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