Twenty-year experience in the treatment of horseshoe perianal fistula by one-stage lay-open operation

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Abstract

Background
Perianal fistula is an abnormal hollow track or cavity that is lined with granulation tissue and that connects a primary opening inside the anal canal to a secondary opening in the perianal skin; secondary tracks may be multiple and can extend from the same primary opening. Horseshoe fistula is a type of trans-sphincteric fistula with multiple complex secondary tracks. Treatment of horseshoe fistula is challenging.
Aim
The aim was to describe the surgical technique that we use for the treatment of horseshoe perianal fistula and to study its effect on recurrence and continence.
Patients and methods
This is a single-center 20-year experience study in the management of horseshoe fistula. A total of 893 patients with horseshoe perianal fistula were enrolled into the study by retrospective method. The study is conducted in Ain Shams University Hospitals. All patients underwent single-stage lay-open technique. Follow-up continued till 2 years after surgery to detect recurrence and/or incontinence.
Results
After 6 months of follow-up, only 71 (7.95%) patients had recurrent fistula. Moreover, 26 patients were incontinent to stool and flatus, 39 patient to gases only, and 34 patients were complaining from staining of the underwear once per week using Wexner score. A total of 794 (88.9%) patients were completely continent to both stool and flatus.
Conclusion
Single-stage lay open is an effective technique to eradicate the complex horseshoe perianal fistula with minimal recurrence and acceptable degrees of incontinence.

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