[Treatment of anal fistulas]

The authors describe the traditional operative technique for correction of anal fistulae and analyse the outcome of surgical treatment. During a 5-years period between 1994 and 1998, 286 patients underwent surgery for anal fistula in the department--more than one--third of this population presented with recurrent disease. During the operation, the extrasphincteric segment of the anal fistula is excised and the margin of the sinus is marsupialized. Introducing a rubber band through the sinus tract eliminates lesions that penetrate the sphincter. As the tied band shears through the encircled sphincter muscle, the rate of transsection is controlled individually, by adjusting the tightness of the rubber band as necessary. The inner opening of the fistula is often difficult to identify and consequently, excision may be incomplete. This is a serious pitfall that commonly leads to recurrence. According to the authors' experience, flushing the fistula tract with hydrogen peroxide is the most effective methods for pinpointing the inner meatus. Using this technique, postoperative recurrence was detected in 30 patients (10%). Moderate impairment of anal continence had been observed in 57 patients (20%); however, this never progressed to permanent incontinence.