括约肌间瘘道结扎术(LIFT)治疗经括约肌隐窝肛瘘:对排便通畅的长期影响。

IF 3.5 3区 医学 Q1 SURGERY
BJS Open Pub Date : 2024-05-08 DOI:10.1093/bjsopen/zrae055
Justin Y van Oostendorp, Carolien Verkade, Ingrid J M Han-Geurts, Grietje J H van der Mijnsbrugge, Dareczka K Wasowicz-Kemps, David D E Zimmerman
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引用次数: 0

摘要

背景:括约肌间瘘道结扎术是一种治疗经括约肌肛瘘的外科技术,旨在保护括约肌的完整性。最近的研究表明,这种方法对瘘管的短期愈合有效,但对排便的影响有限。然而,有关长期疗效(包括复发和肠道通畅)的全面前瞻性数据却很有限。本研究旨在报告长期功能结果:方法:对2012年7月至2018年10月期间在荷兰两家转诊中心接受括约肌间瘘道结扎术治疗经括约肌隐窝肛瘘的患者进行回顾性研究。主要研究结果是括约肌间瘘道结扎术后的长期排便连续性,采用的是大便失禁严重程度指数。通过电子记录和Rockwood问卷调查获得了有关排便连续性、愈合率和复发率的短期数据(2018年收集)和长期数据(2023年收集)。结果:在纳入的 110 名患者中(50% 为女性,中位随访时间为 92 个月),101 名患者(92%)曾接受过手术治疗(中位数为 2 次,范围为 0-6 次),80% 的患者曾接受过套管引流术。在结扎括约肌间瘘道前,16%的患者报告有大小便失禁(平均(s.d.)大便失禁严重程度指数:2.4(7.5)):结扎括约肌间瘘道后,在短期随访中,报告大便失禁的患者比例增至 18%,其中包括 11% 的新发病例。使用洛克伍德调查问卷对 69 名患者进行了长期随访(回复率为 63%),发现失禁率为 74%(平均(s.d.)粪便失禁严重程度指数:9.22(9.5)):9.22(9.5).在没有进行后续手术的患者中,49%(35 人中有 17 人)在长期随访中报告有大小便失禁。结扎括约肌间瘘道后,原发性瘘管愈合率为 28%。术前套管引流明显提高了愈合率(33% 对 9%)。值得注意的是,43%(79 例中的 34 例)未愈合的瘘管转变为括约肌间瘘道;在这些患者中,有 19 例接受了后续的瘘管切开术治疗,其中 18 例治愈:结扎括约肌间瘘道的治愈率低于最新文献标准。结论:括约肌间瘘管的结扎愈合率低于最新的文献标准。虽然对术后尿失禁的直接影响似乎很小,但长期尿失禁率令人担忧。在认识到个人尿失禁情况恶化的同时,我们提倡以患者为中心的方法,并敦促同行研究人员和临床医生收集全面的前瞻性尿失禁数据。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Ligation of intersphincteric fistula tract (LIFT) for trans-sphincteric cryptoglandular anal fistula: long-term impact on faecal continence.

Background: The ligation of intersphincteric fistula tract is a surgical technique designed to treat trans-sphincteric anal fistulas aiming to preserve sphincter integrity. Recent studies suggest its efficacy in short-term fistula healing with limited impact on continence. However, comprehensive prospective data on long-term outcomes, including recurrence and bowel continence, are limited. The present study aims to report on the long-term functional outcomes.

Methods: Patients who underwent the ligation of intersphincteric fistula tract procedure for trans-sphincteric cryptoglandular anal fistulas between July 2012 and October 2018 at two Dutch referral centres were retrospectively reviewed. The primary outcome of interest was the long-term bowel continence after the ligation of intersphincteric fistula tract procedure, using the faecal incontinence severity index. Short-term data (collected in 2018) and long-term data (collected in 2023) on bowel continence, healing rates and recurrences were obtained through electronic records and Rockwood questionnaires. Sankey diagrams were used to visually represent individual variations in continence status (preoperative versus follow-up).

Results: Among 110 patients included (50% female, median follow-up 92 months), 101 patients (92%) were treated with previous surgeries (median 2, range 0-6) and 80% had previous seton drainage. Preligation of intersphincteric fistula tract, 16% of the patients reported incontinence (mean(s.d.) faecal incontinence severity index: 2.4(7.5), increasing to 18% after ligation of intersphincteric fistula tract at short-term follow-up, including 11% newly induced cases. Long-term follow-up collected using Rockwood questionnaires (63% response rate) in 69 patients uncovered a 74% incontinency rate (mean(s.d.) faecal incontinence severity index: 9.22(9.5). In those patients without subsequent surgery 49% (17 of 35) reported incontinence at long-term follow-up. Primary fistula healing after ligation of intersphincteric fistula tract was 28%. Preoperative seton drainage significantly improved healing rates (33% versus 9%). Notably, 43% (34 of 79) of unhealed fistulas transitioned into intersphincteric tracts; in these patients, 19 were treated with subsequent fistulotomy achieving cure in 18 cases.

Conclusions: Ligation of intersphincteric fistula tract healing rates fell below recent literature standards. Although the immediate impact on postoperative continence appears minimal, long-term incontinence rates are concerning. In recognizing the deterioration of individual continence, we advocate for a patient-centered approach and urge fellow researchers and clinicians to collect comprehensive prospective continence data.

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BJS Open
BJS Open SURGERY-
CiteScore
6.00
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3.20%
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