Coring Out Fistulectomy with Closure of Internal Sphincter Opening Versus Lay Open Fistu-lotomy and Primary Sphincter Repair in Transsphincteric Perianal Fistula; A Prospective Randomized Comparative Study, | ||
| The Egyptian Journal of Surgery | ||
| Article 4, Volume 44, Issue 3, July 2025, Pages 842-847 PDF (519.55 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/ejsur.2024.341606.1300 | ||
| Authors | ||
| Mohamed Ibrahim Ali Ahmed* ; Mohamed Ali Mohamed Nada; Ibrahim Maged Abdel-Maksoud | ||
| Department of General Surgery, Faculty of Medicine, Ain Shams University, Egypt | ||
| Abstract | ||
| Background: Surgical The treatment of transsphincteric fistulas is extremely difficult, and new methods are being developed every day in an effort to find the safest and most efficient approach. Based on their post-operative results, two of the most successful procedures are compared in this study. Objective: To compare the postoperative outcomes (such as postoperative pain, wound infection, incontinence, and recurrence at 1 year) of coring out fistulectomy with closure of the internal sphincter opening versus lay open fistulotomy with primary sphincter repair in transsphincteric per-ianal fistula. Patients and Methods: The current study, which took place at Ain Shams University Hospitals from November 2022 to April 2023 and follow up ended at April 2024, was a prospective, randomized, controlled, single-center, single-blind trial. 60 patients presented with transsphincteric perianal fistulas, with a postoperative follow-up of one year. Results: In our study, there were sixty patients, thirty in each group. In this sense, 2 patients in group I and 5 patients in group II presented a postoperative wound infection (p= 0.424). In group I, no cases of incontinence, however, six cases of gas incontinence in group II received only a Wexner score of 3/20 (p= 0.026), indicating a significant difference between the two methods. Recurrence during the 1-year follow-up occurred in 11(36.7%) patients in group (I). While in group II, recurrence occurred in 2 patients (6.7%) with high statistical significance given that the p value is ≤0.005. Conclusion: Compared with modified LIFT, fistulotomy with primary sphincteroplasty is a highly successful procedure for transsphincteric fistula repair, with a statistically significant reduced recurrence rate at 1-year follow-up. However, the incidence of gas incontinence is higher. | ||
| Keywords | ||
| Fistulotomy; Fistulectomy; High Trans-Sphincteric Fistula; Modified LIFT; Primary Repair | ||
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