Management of fistula-in-ano at King Hussein Medical Center

Abstract EN

Objective : to describe the treatment of fistula-in-ano in the newly formed colorectal unit at King Hussein Medical Center. Methods : this is a descriptive, retrospective review of case medical records of 91 patients with different types of fistula-in-ano treated surgically between March 2009 and May 2011.

Anatomic classification and operative procedure of all fistulae were recorded. Results : Eighty-five patients underwent surgery for fistula-in-ano.

There were 93 fistulae in our study group; with eight patients having two fistulae tracts.

There were 76 (89%) males, with a mean age of 39.1 years (range 19-76).

Eleven patients had superficial, 5 patients had inter-sphincteric, 68 patients had trans-sphincteric, 3 patients had supra-sphincteric and 5 patients had extra-sphincteric fistulae.

Thirty-eight patients (45%) had complex fistulae.

The radial site of fistulae was detected, with 44 (47 %) presenting with an internal opening in the posterior anal canal, 19 (21 %) opening into the anterior canal and 30 (32 %) opening laterally.

Fistulotomy was the commonest procedure (n = 40) with marsupialization in 20 patients, followed by loose Seton (n = 33), endorectal advancement flap (n=5), tight Seton (n = 4) and ligation of the intersphincteric fistula tract (LIFT) procedure (n = 2). Conclusions : careful selection of the treatment method that takes into account the anatomy of the fistula, state of the anal sphincters and patient’s preference is central in the successful management of fistula-in-ano.