A study of Constipation after surgery for anorectal malformations in a tertiary hospital in Central India

Abstract

Background: Perianal sepsis and anal fistula are troublesome diseases in the field of colorectal surgery due to recurrence and fecal incontinence.
Aim: To investigate the role of "one-stage complex anal fistula resection with anal sphincter reconstruction without stool diversion" on fecal incontinence and recurrence.
Methodology: This is a prospective cohort study of 350 patients with complex perianal fistulas who underwent fistulectomy and anal sphincter reconstruction (primary suture repair) without stool diversion; Patients were followed up for 1 year after the operation after complete healing of the wound. Suppression of stool and gas was assessed using the Wexner score and fistula recurrence was assessed clinically and radiologically using MRI. Out of 350 patients, only 8 had different degrees of fecal incontinence: 4 had gas incontinence, 4 had soil incontinence, and 16 had relapse after 3 months. 12 people relapsed after 6 to 9 months. Confirmatory MRI was also performed at the end of the follow-up period and two patients had hidden fistula ducts leading to the upper abscess cavity. This resulted in 32 recurrent cases. 10 patients had delayed wound healing.
Conclusion:As compared to other treatment methods for complex anal fistulas described in the literature, one-stage surgery (hemorrhoidectomy with primary sphincter repair) has a lower risk of incontinence, a lower recurrence rate, and better anal fistula formation. It gave good results in terms of wound healing.