EFFECTS OF FISTULECTOMY ON ANAL SPHINCTER PRESSURES

Abstract

Purpose: The study was aimed at assessing the impact of fistulectomy on clinical and manometric parameters of anal continence.

Material and Methods: A prospective study was conducted in 62 patients of fistula-in-ano who were admitted for surgery. Patients were evaluated using anorectal manometry and Cleveland Clinic Incontinence Scoring System (Wexner Scale). The evaluation was done pre-operatively, followed at 6 weeks and 3 months post-operatively. The mean duration of the follow-up for all patients was 18 months.

Results: The mean age of the patients was 38.7±13.1 years. 30 patients (48.4%) had simple fistula and 32 patients (51.6%) had complex fistula. 9 patients had recurrent fistula-in-ano. The present study suggested good functional outcome after fistulectomy for fistula-in-ano. Clinical parameters suggested little impairment of continence in our study group, while, manometry suggested no significant impact on anal sphincter pressures. However, clinical parameters suggested deteriorating continence in the early post-operative period with significant increase in mean Wexner score [0.98±2.98 (p: 0.017)]. There was also a significant change in manometric variables with increase in mean resting pressure [41.8±18.67mmHg (p<0.001)] and a fall in mean maximum squeeze pressure [107.1±36.47mmHg (p<0.001)]. parameters.inence was significantly impacted in early post-operative period which was suggested by both clinical and manometri The results of our study indicate an overall post-operative incontinence of 11.3% (3.3% for simple fistula and 18.7% for complex fistula) at 18 months follow-up.

Conclusion: Although the study group was small, the present study demonstrated that standard fistulectomy, fistulectomy with sphincter reconstruction or Seton use can all provide good results in experienced hands with no significant changes in anorectal pressures. More large scale studies may be needed to further establish the findings of the current study.