Volume 26, Issue 121, March 2022

Using Minimally Invasive Sphincter-Sparing Techniques of Surgical Treatment of Transsphincteric Anal Fistulas: A Focus on Preserving Anal Sphincter Function

Igor A. Kryvoruchko^1♦, Valeriy V. Boyko^2,3, Massimo Sartelli⁴, Tetayna M. Firsyk¹, Marina S. Antonova¹

¹Kharkiv National Medical University, Department of Surgery №2, Kharkiv, Ukraine
²Kharkiv National Medical University, Department of Surgery №1, Kharkiv, Ukraine
³Institute General and Emergency Surgery named after V.T. Zaitcev of the National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine
⁴Department of Surgery, Macerata Hospital, Macerata, Italy

^♦Corresponding author
Professor Igor A. Kryvoruchko, Kharkiv National Medical University, Kharkiv, Ukraine

ABSTRACT

Background: The existing recommendations for the diagnosis and treatment of anal cryptoglandular transsphincteric fistulas (AF) are contradictory, which makes practical decisions in its treatment extremely difficult. Methods: 82 patients were examined after surgery for AF. All the patients were divided into three groups: the first included patients who underwent fistulotomy (n = 17) and fistulectomy (n = 9); the second, who underwent ligation of the intersphincteric fistula (LIFT, n = 29); and the third, treated with bio-welding of the AF (n = 27). Results: Positive short-term results were obtained in all groups, in 53.8%, 82.8%, and 85.2% of cases, respectively. The effect of bio-welding of AF was achieved due to electrothermal denaturation and the appearance of common space between protein molecules with a small area of heat propagation, less than 1–2 mm. The immunohistochemical studies showed that cells had produced neutrophilic granulocytes and pro-inflammatory interleukins in both the intra- and extrasphincteric parts of AF. The average follow-up period for patients after bio-welding was 8.8±4.6 after LIFT was 9.6±4.6, and in the group, who underwent fistulotomy and fistulectomy, was 9.8±4.8 months; satisfactory long-term results of treatment were noted in 92.6%, 89.7% and 62.2% of cases, respectively. Conclusion: Suggested surgery techniques in AF have made it possible to personalize surgical tactics and improve the treatment. The cryptoglandular theory of AF seems controversial considering the data of our study.

Keywords: transsphincteric AF, intersphincteric fistula ligation, seton, fistulectomy, bio-welding, cryptoglandular theory of AF

Medical Science, 2022, 26, ms101e2096

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DOI: https://doi.org/10.54905/disssi/v26i121/ms101e2096

Published: 16 March 2022