대한대장항문학회

Purpose : Horseshoe type-ischiorectal fistula is originating initially from infected anal gland<br>that connect with an anal crypt usually situated in the posterior midline of the anal canal. In<br>the modified Hanley's operation, a prove inserted into the primary opening in directed into the<br>posterior anal space. A straight incision from the primary opening toward the tip of the<br>coccyx is made to unroof the posterior anal spcae and the anal portion of the fistulous tract.<br>The secondary external fistula openings are incisied to permit better external drainage. The<br>tracts are curratted but their entire lengths are not unroofed. This study presents the clinical<br>features and the results obtained with modified Hanley's operation in the surgical<br>management of horseshoe fistula. Methods : This report is based on the clinical analysis of 22<br>cases of horseshoe type among 329 cases of fistula in ano, which were treated at the<br>Department of General Surgery of Ewha Womans University Hospital from October 1993 to<br>May 1998. Results : The male to female ratio was 3.7：1 and the age was range from 19<br>years-old to 61 years-old. The symptom were anal discharge and pain. The previous or<br>combined anal disease were anal abscess and hemorrhoids. The internal openings were<br>located at the dentate line in 18 cases and anterior portion in 5 cases. Horseshoe ischorectal<br>fistula included 17 cases of semi- horseshoe fistula and 1 case of horseshoe fistulous sinus.<br>The spinal anesthesia and lithotomy position was used for operations. The cutting seton was<br>applied in the 4 cases for preservation of sphincter function. The average hospital stay was<br>7.6 days and average wound healing time was 5.4 weeks. The postoperative complication of<br>urinary retension<br>was found in the 2 cases. Recurrence, fecal incontinence, anal deformity and anal anterior<br>diaplacement was not developed during following periods. Conclusions : We confirm that the<br>modified Hanley's operation is a effective and conservative surgical procedure that minimizes<br>the disadvantages of complete unroofing method & useful method for preservation of<br>sphincter function.<br>