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Changes in anorectal morphologic and functional parameters after fistula-in-ano surgery
José V Roig1, Julio Jordán, Juan García-Armengol
1Unidad de Coloproctología, Servicio de Cirugía General y Digestiva, Consorcio Hospital General Universitario de Valencia, Valencia, Spain. roig_jvi@gva.es
Diseases of the Colon and Rectum
|July 21, 2009
Summary
Fistula-in-ano surgery significantly impacts anal continence, often causing sphincter damage and reduced anal pressures. Preoperative identification of sphincter defects is crucial for effective surgical treatment and improved outcomes.
Area of Science:
- Colorectal Surgery
- Gastroenterology
- Surgical Outcomes Research
Background:
- Fistula-in-ano is a common condition requiring surgical intervention.
- Complex and recurrent fistulas present significant treatment challenges.
- Assessing the impact of surgery on anorectal function is critical for patient well-being.
Purpose of the Study:
- To analyze changes in anal continence following fistula-in-ano surgery.
- To evaluate morphologic and functional anorectal variables pre- and post-operatively.
- To investigate the impact of complex fistulas on surgical outcomes.
Main Methods:
- Prospective analysis of 120 patients undergoing fistula-in-ano surgery.
- Evaluation of anal continence, endoanal ultrasound, and anorectal manometry.
- Measurement of pudendal nerve terminal motor latency before and after surgery.
Main Results:
- Nearly 50% of patients experienced incontinence post-surgery, a significant increase (P < 0.001).
- Rectal advancement flap and fistulotomy techniques most affected continence.
- Endoanal ultrasound revealed increased internal and external anal sphincter defects post-surgery (P < 0.001).
- Anal manometry showed decreased pressures, particularly with fistulotomy and in patients with sphincter defects.
Conclusions:
- Fistula-in-ano surgery significantly compromises anal continence due to sphincteric lesions.
- Endoanal ultrasound is valuable for imaging post-surgical sphincter defects.
- Preoperative assessment of sphincter integrity is essential for selecting appropriate surgical techniques.
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