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2019, Number 4

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Rev Med MD 2019; 10.11 (4)

Time of healing and impact on fecal continence according to the Wexner scale between fistulotomy and fistulectomy for the management of perianal fistulas

Beltrán-Ríos D, Latorraca-Santamaría JI, González-Duarte JA, Betancourt-Vicencio S, Esparza-González A, Delgado-Garay FG, Álvarez-Zavala M, Enciso-Pérez D, Magaña-Vaca JF, Hernández- Gómez F, Zepeda-Solís C, Navarro-Lara E

Language: Spanish
References: 42
Page: 259-264
PDF size: 544.12 Kb.


ABSTRACT

Introduction. The management of anal fistulas represents a challenge for the surgeon due to the heterogeneity of the condition and the potential adverse events on the anal continence of surgical treatment. Fistulotomy and fistulectomy are the two main surgical techniques used in this entity. Because the information on these surgical techniques is varied by the design of the studies and the heterogeneity of the populations studied, the objective of this study was to describe and compare the impact on anal continence according to the Wexner scale and epithelialization time of the surgical wound in Mexican population in a reference hospital.
Methods. It was a retrospective analytical study in which all individuals with a diagnosis of perianal fistula were included who were treated in the coloproctology service of the Hospital Civil de Guadalajara Fray Antonio Alcalde during the period from January 2016 to November 2018 The clinical, demographic characteristics, the type of procedure used (fistulotomy or Fistulectomy), the healing time and the Wexner scale scores before and after surgery were analyzed. Descriptive statistics were used. Categorical variables were compared with χ2 test or Fisher’s exact test; the continuous variables using Student’s t or U of Mann-Whitney, according to their distribution. For multiple continuous variables, they were compared with ANOVA or Kruskal Wallis. To investigate the association of the variables with incontinence, a univariate and multivariate analysis was performed using logistic regression, taking for the multivariate analysis the variables that had a value of p ‹0.2 in the univariate analysis. Multiple regression was performed to investigate the association of variables with healing time. A value of p ‹0.05 was determined statistically significant.
Results. Of the 140 patients were analyzed. 88 of them (63%) had fistulectomy. The majority were men of the fifth decade of life. There was no difference in terms of evolution time; history of previous anorectal surgery; comorbidities nor in the complexity of the fistulas between both groups. In the fistulectomy group, a greater number of plasties were performed, they had a higher proportion of incontinence and more time for healing. While in the fistulotomy group, more post-surgical complications were reported, where the surgical wound hematoma was the most frequent. 21 individuals (15%) presented some degree of continence alteration according to the Wexner scale. The variables associated with the development of incontinence were the history of fistulectomy and the classification of the fistula according to the Parks classification.
Discussion. In our center, fistulectomy has a longer time for scarring and a greater proportion of incontinence compared to fistulotomy. However, the first was performed in a greater proportion for the treatment of complex fistulas. This first report provides valuable information about our hospital experience and provides the opportunity to conduct prospective comparative studies between these two techniques.


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