Results and Assessments of Sphincter Preserving, Myoplasty Operation for Anal Fistulas in Adults and Silk Tight Seton for Fistulas in Infants

Abstract

Sphincter preserving operation and radicality are needed to treat anal fistulas. Different methods that were suitable for the site of internal opening and for four major types of fistula in ano, based on the idea of 'complete removal of primary focus' were selected.
Anterior and lateral originated low intersphincteric fistulas were treated by three different methods. Fistulectomy for posterior low intersphincteric fistulas and myoplasty after removal of primary focus were performed for complicated trans-and supra-sphincteric fistulas. In 174 anterior and lateral low intersphincteric fistulas during '81-94, closure of the internal opening by primary suture, sliding or rotating skin flap, and coring-out methods had been done, and the recurrence rates were 4.7%, 2.3%, and 11% respectively. The recurrent cases were treated by the rotating skin flap method or seton.
Recurrence after myoplasty for 152 complicated fistulas was 6 cases (3.5%). Surgical treatment for fistulas of male infants by silk tight seton was excellent. On assessment of recurrent cases, recurrence was caused by inappropriate removal techniques of primary focus rather than the operation method.