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Factors affecting continence after surgery for anal fistula
P J Lunniss1, M A Kamm, R K Phillips
1Department of Surgery, St. Bartholomew's Hospital, London, UK.
The British Journal of Surgery
|September 1, 1994
Summary
Surgery for chronic perianal sepsis can impact anorectal function. Internal anal sphincter division significantly reduces resting pressure, potentially leading to incontinence, especially when combined with scarring.
Area of Science:
- Colorectal surgery
- Anorectal physiology
- Fecal incontinence research
Background:
- Chronic perianal sepsis presents complex challenges in maintaining anorectal function and continence.
- Surgical interventions for these conditions often involve anal sphincter manipulation, raising concerns about functional outcomes.
Purpose of the Study:
- To prospectively assess the impact of surgical interventions for chronic perianal sepsis on anorectal physiology and continence.
- To identify factors influencing functional outcomes and incontinence post-surgery.
Main Methods:
- Prospective assessment of anorectal physiology and continence in 50 patients with chronic perianal sepsis before and after surgery.
- Comparison of outcomes between control patients (sepsis without sphincter division) and two surgical groups (internal sphincter division alone vs. trans-sphincteric fistula laid open).
- Measurement of resting and squeeze pressures, and assessment of functional deficit and incontinence.
Main Results:
- Internal anal sphincter division significantly reduced resting anal pressure in both surgical groups (P < 0.001 and P = 0.003).
- Functional deterioration occurred in 11/22 patients with internal sphincter division and 8/15 patients with trans-sphincteric fistula laid open.
- Incontinence correlated with reduced resting pressure (internal sphincter integrity) and local epithelial electrosensitivity (scarring), but not with fistula type or specific surgical technique.
Conclusions:
- Surgical division of the internal anal sphincter for chronic perianal sepsis leads to a significant reduction in resting anal pressure.
- Post-operative incontinence is associated with the degree of internal sphincter damage and local tissue scarring, highlighting the importance of preserving sphincter integrity and minimizing operative scarring.