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Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Online ISSN 1827-1782
Ballari F., Bruzzone D., Comola C., Zaffarano R., Accarpio G.
Background. Treatment of anal fistulas, diversified on the basis of the type of fistula and school of surgery that performs the operation, is unanimously and, in our opinion rightly, considered to be ''minor'' surgery. By no means ''minor'', however, are the outcomes and complications that may present even following appropriate treatment of some anal fistulas. The purpose of the present paper is to analyse the question, paying particular attention to the sequelae which in some cases may be invalidating and unavoidable, even in the case of ''gold standard'' treatment.
Methods. Over the past five years we have treated: 395 inferior transphincteric fistulas (55.3%), 265 superior transphincteric fistulas, 36 intersphincteric fistulas (5.1%) and 18 suprasphincteric fistulas (2.5%) with a decided prevalence of males (5:1).
Results. The most frequent complications were haemorrhage in the immediate postoperative period, recurrence, a posteriori recognition of mistakenly read passages and perineal sepsis. Of these 654 treated fistulas only those involving the sphincters presented outcomes that could be related to continence, in particular in 7.3% of cases a hypocontinence to gases and liquid faeces was evidenced. For this reason we recommend anorectal manometry preoperatively and after one month in order to document the possible diminution of sphincterial continence. In any case, it is necessary to exclude (by opaque clysma X-ray, fistulography and possibly magnetic resonance) all those pathologies that might occur in the first instance with perianal fistulas (Crohn's disease, ulcerous recto-colitis, adk of the fistulised rectum).
Conclusions. In conclusion we consider it necessary for the patient to be adequately informed of the type of fistula concerned, of the treatment he needs, and of the possible complications, without underestimating the gravity of the possible outcomes.