Abstract
Aim
The aim of this study was to evaluate combined fistulotomy and/or seton application for the management of multiple cryptoglandular anal fistulas in terms of recurrence and postoperative fecal incontinence.
Patients and methods
This study was carried out in Alexandria Main University Hospital, Alexandria, Egypt, by revising the medical files of all patients with multiple anal fistulas, who underwent fistulotomy, seton application or combined techniques, during the period spanning from December 2013 to June 2016.
Results
Twelve (10 male patients and two female patients) patients were reviewed, with a mean age of 41.75 +/- 7.75 years. Number of multiple fistulas had a mean of 2.58 +/- 0.90. For 11 patients, fistulotomy was performed for one or two fistulas (intersphincteric or low trans-sphincteric). The rest of the fistulas were treated by two-stage seton fistulotomy or draining seton application. One patient had two high trans-sphincteric anteriorly located fistulas, and both were treated by application of a draining seton. Among 31 fistulas in our patients, recurrence was encountered in two anterior high trans-sphincteric fistulas (6.4%) in two (16.7%) patients. Twelve months after the last intervention, our patients expressed acceptable continence status.
Conclusion
The condition of multiple cryptoglandular anal fistulas is an uncommon category of anal fistula. MRI is a perfect tool to diagnose the condition preoperatively. Combined fistulotomy and seton application seem a safe strategy for management of multiple anal fistulas with low postoperative recurrence and good postoperative continence. Further studies are required to explore more details about this neglected category of anal fistula.