Abstract
Despite modern surgical techniques, anal fistulas are still a challenge in colorectal surgery. In former years, the standard of care was complete fistulectomy with a high rate of continence disorders. Over the past 20–30 years, sphincter-saving procedures have gained wide acceptance. They represent the technique used in these cases. Also, many patients stayed with a long-term seton as definite treatment. The main problem of all surgical possibilities is a high recurrence rate with 30–50% in flap procedures and 100% of persistence in seton treatments. In recent years we started to do a direct repair (primary reconstruction) in distal fistulas with excellent results and evolved our technique for proximal (high) anal fistulas. Our results demonstrated that fistulectomy with primary sphincter reconstruction is a safe and feasible procedure for both distal and intermediate transsphincteric fistulas alike, showing higher rates of healing than other procedures. Even in proximal (high) transsphincteric and suprasphincteric fistulas, the procedure shows comparable healing rates compared to other procedures. Continence disorders are of minor relevance and consequence for these patients.
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Herold, A. (2022). Utility of Adding Sphincter Reconstruction to Fistulotomy/Fistulectomy. In: Ratto, C., Parello, A., Litta, F., De Simone, V., Campennì, P. (eds) Anal Fistula and Abscess. Coloproctology. Springer, Cham. https://doi.org/10.1007/978-3-030-76670-2_21
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DOI: https://doi.org/10.1007/978-3-030-76670-2_21
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