Fistulotomy and drainage of deep postanal space abscess in the treatment of posterior horseshoe fistulaReportar como inadecuado

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BMC Surgery

, 3:10

First Online: 26 November 2003Received: 31 July 2003Accepted: 26 November 2003


BackgroundPosterior horseshoe fistula with deep postanal space abscess is a complex disease. Most patients have a history of anorectal abscess drainage or surgery for fistula-in-ano.

MethodsTwenty-five patients who underwent surgery for posterior horseshoe fistula with deep postanal space abscess were analyzed retrospectively with respect to age, gender, previous surgery for fistula-in-ano, number of external openings, diagnostic studies, concordance between preoperative studies and operative findings for the extent of disease, operating time, healing time, complications, and recurrence.

ResultsThere were 22 88% men and 3 12% women with a median age of 37 range, 25–58 years. The median duration of disease was 13 range, 3–96 months. There was one external opening in 12 48% patients, 2 in 8 32%, 3 in 4 16%, and 4 in 1 4%. Preoperative diagnosis of horseshoe fistula was made by contrast fistulography in 4 16% patients, by ultrasound in 3 12%, by magnetic resonance imaging in 6 24%, and by physical examination only in the remainder 48%. The mean ± SD operating time was 47 ± 10 min. The mean ± SD healing time was 12 ± 3 weeks. Three of the 25 patients 12% had diabetes mellitus type II. Nineteen 76% patients had undergone previous surgery for fistula-in-ano, while five 20% had only perianal abscess drainage. Neither morbidity nor mortality developed. All patients were followed up for a median of 35 range, 6–78 months and no recurrence was observed.

ConclusionsFistulotomy of the tracts along the arms of horseshoe fistula and drainage of the deep postanal space abscess with posterior midline incision that severs both the lower edge of the internal sphincter and the subcutaneous external sphincter and divides the superficial external sphincter into halves gives excellent results with no recurrence. When it is necessary, severing the halves of the superficial external sphincter unilaterally or even bilaterally in the same session does not result in anal incontinence. Close follow-up of patients until the wounds completely healed is essential in the prevention of premature wound closure and recurrence.

List of abbreviationsUSUltrasound

MRIMagnetic Resonance Imaging

SDStandard Deviation

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2482-3-10 contains supplementary material, which is available to authorized users.

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Autor: Resit Inceoglu - Rasim Gencosmanoglu


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