Long-term Results of Anal Fistula

Abstract

Anal fistula is one of the most difficult anal diseases to cure because of the tendencies for recurrence and insufficiency. To understand the postoperative long-term results, the 204 cases who underwent surgery in our hospital in 1991 were surveyed. The 204 cases were 12 cases of subcutaneous, 141 low intersphincteric, 20 high intersphincteric, 25 ischiorectal and 6 pelvirectal fistulas. The operative methods were open for subcutaneous and posterior low intersphincteric fistulas and sphincter-preserving methods for the other fistulas. As a result, the wounds healed completely after 23.6 days postoperatively in average. The postoperative complaints decreased to 73 from the preoperative 387 complaints. Most of the persisting postoperative complaints seemed to originate from 2 factors of accompanied lesions left behind after operation such as hemorrhoids and postoperative deformity and/or minor insufficiency. In order to prevent postoperative complaints, curative operation of the accompanied lesions and protection of normal anatomy are needed. Only 4 cases (2.0%) showed manifest symptoms of anal insufficiency postoperatively. Manometry revealed declined anal pressures in deeper types of fistulas, among which the deepest pelvirectal fistula did not recover after radical operation. Recurrence occurred in 6 cases (2.9%) consisting of a case of short-term recurrence and 5 cases of long-term recurrence, all of which healed well after the second reoperation.