대한대장항문학회

Purpose : The results for treatment of fistula-in-ano have much improved, along with the<br>development of anatomical knowledge, classification, and operative techniques, during last<br>several decades. The authors retrospectively reviewed the results for treatment of<br>fistula-in-ano, especially complex fistulas, during the last 11 years. Method : A retrospective<br>study of fistula-in-ano was performed for 229 patients who had been operated on in St.<br>Benedict Hospital between January 1988 and December 1998. Complex fistulas (IIH, III & IV)<br>were analyzed separately. Results : The most common type was IILs (92 cases, 40.2%), and<br>the most common horseshoe type was IIIBc (5 cases, 2.2%). The average hospital stay was<br>11.5 days for all fistula-in-ano types, but 15.1 days for complex fistulas. Non-specific<br>inflammation (209 cases, 91.3%) was the most common pathologic finding. Various operative<br>procedures were used : fistulotomy (80 cases, 34.9%), fistulectomy (74 cases, 32.3%), coring<br>out fistulectomy (63 cases, 27.5%), seton technique (11 cases, 4.8%), and muscle-filling<br>technique (1 case, 0.4%). There was no difference in the recurrence rate among the operative<br>types. Various procedures were tried for complex fistulas, but the sphincter-preserving<br>fistulectomy by Takano seemed to have a low recurrence rate and a short postoperative<br>course. However, because of the small number of cases, this difference in recurrence rate and<br>postoperative course was not statistically significant. The overall postoperative complication<br>rate was 7%: anal infection (4 cases, 1.7%), anal bleeding (3 cases, 1.3%), and urinary<br>retention (2 cases, 0.9%). Conclusions : The operations for most of the fistulae, IH, IL & IIL,<br>were simple and uneventful. However, the operations for complex fistulae were complicated<br>and more skill was required. We have thought Takano's operation to be a good curative<br>procedure with less postoperative deformity and shortened postoperative course. However this<br>research couldn't prove that with statistical significance, probably because of the insufficient<br>number of patients. If further cases are collected and continuous follow-up is done, then a<br>better result can be expected.<br>