结直肠肛门外科 (Dec 2022)
Comparison between contra-incision combined with high loose-tight thread and traditional incision-thread-drawing procedure for high complex anal fistula
Abstract
[Objectives] To compare the effectiveness between contra-incision combined with high loose-tight thread and traditional incision-thread-drawing procedure for treating high complex anal fistula. [Methods] Sixty-eight patients with high complex anal fistula treated at the Department of Anorectal Diseases, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, between October 2020 and October 2021 were recruited and randomly assigned to the treatment group (n=34, receiving contra-incision combined with high loose-tight thread) and the control group (n=34, receiving traditional incision-thread-drawing procedure). Time to wound healing and local symptoms (wound bleeding, wound oozing, anal distension, and wound pain) were compared between the two groups 3 and 7 days after surgery. The incidence of postoperative urinary retention, clinical effectiveness, recurrence rate, and anal function (Wexner anal incontinence score, anal maximum contraction pressure, and anal resting pressure) before and 6 months after surgery were also compared between the two groups. [Results] Time to wound healing was significantly shorter in the treatment group than in the control group (P0.05). The score of wound oozing at 3 days after surgery was significantly higher, and the score of anal distention at 3 days after surgery was significantly lower in the treatment group than in the control group (P0.05). Scores of wound pain 3 and 7 days after surgery were significantly lower in the treatment group than in the control group (P0.05). At 3 months after surgery, the overall effectiveness rate did not differ significantly between the two groups (P>0.05). Patients were followed for 6 months after anal fistula were cured, and there was no recurrence. Before surgery, the two groups did not differ significantly in Wexner anal incontinence score, anal maximum contraction pressure, and anal resting pressure (P>0.05). Six months after surgery, Wexner anal incontinence score increased significantly after surgery in the control group (P<0.05); anal maximum contraction pressure and anal resting pressure decreased significantly after surgery in both groups (P<0.05); compared with the control group, the treatment group had significantly lower Wexner anal incontinence score and higher anal maximum contraction pressure (P<0.05). [Conclusion] Compared with traditional incision-thread-drawing procedure, contra-incision combined with high loose-tight thread for high complex anal fistula can achieve comparable effectiveness and recurrence rate and shows benefits of shorter time to wound healing, less postoperative anal distension, less wound pain, and better anal function.
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