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Related Experiment Videos

Open coring-out (function-preserving) technique for low fistulas

Y Hongo1, A Kurokawa, Y Nishi

  • 1Hongo Surgical Clinic, Hiratsuka, Japan.

Diseases of the Colon and Rectum
|October 23, 1997
PubMed
Summary

A novel "open coring-out" surgical technique for low anal fistulas preserves sphincter function and reduces complications. This method, developed in 1984, offers a simple, low-infection approach with improved healing rates.

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Area of Science:

  • Colorectal Surgery
  • Surgical Innovation
  • Anal Fistula Treatment

Background:

  • Anal fistula operations can severely damage anal sphincters, leading to functional abnormalities and incontinence.
  • Low anal fistulas, traversing thin sphincter muscle layers, present unique challenges for function-preserving surgery.
  • Traditional methods often result in significant postoperative morbidity, emphasizing the need for improved techniques.

Purpose of the Study:

  • To present a function-preserving surgical technique for treating long, string-type low anal fistulas.
  • To detail the "open coring-out" method for excising infected anal glands and fistula tracts.
  • To evaluate the efficacy and safety of this specialized surgical approach.

Main Methods:

  • Developed an "open coring-out" technique to fully visualize and excise the fistula tract and primary focus (infected anal gland).

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  • Employed fistulotomy for the tract and fistulectomy for primary focus excision.
  • Utilized specific sphincter muscle repair sutures to fix edges and prevent pocket formation, ensuring adequate drainage.

    • Main Results:

    • Treated 319 patients with low fistulas since 1984; 52 required postoperative treatment.
    • Reported a recurrence rate of 4.2% (4 patients) and delayed healing in 48 patients.
    • Postoperative complaints were reported by 6.4% of surveyed patients, with delayed healing rates reduced to ~7% in recent years due to improved repair.

    Conclusions:

    • The "open coring-out" technique is a simple, effective method for treating low anal fistulas.
    • The technique demonstrates a low risk of infection and preserves anal sphincter function.
    • It successfully prevents anal verge and perineal deformity, improving patient outcomes.