الفهرس 
ANATOMY AND EMBRYOLOGYOnly 14 pages are availabe for public view
 |  | from | 121 |  |  |
| | | from | 121 | | |
Abstract
Perianal fistula is a chronic anorectal infection that predominantly affects patients in their active years of life. Some cases of specific anal fistula, such as Crohn’s fistula, could be treated medically; however, surgery is the only curative treatment for cryptogenic anal fistula. Operations for anal fistula can be divided into sphincter-preserving and sphincter-sacrificing techniques. The former is known to be associated with more recurrence and less incontinence, whereas the latter is associated with less recurrence and significant postoperative incontinence [1–3]. Incontinence associated with sphincter-sacrificing operations is related to the amount of sphincter divided, and in high arching transsphincteric fistula, the continence mechanism may be seriously affected after fistulotomy.
Objective: To compare the outcome of one stage lay open operation with primary sphincter repair versus staged rerouting operation for high trans-sphincteric perianal fistula to detect their effect on recurrence and continence.
Patients and Methods: 60 consecutive patients with high transsphincteric perianal fistula were enrolled into the study by prospective method, after ethical committee approval. All the patients signed an informed written consent. Fistulae were assessed clinically and by MRI when the clinical diagnosis was unclear. Preoperative continence status was assessed using the Wexner incontinence score. Preoperative incontinence did not exclude patients from the study, but its degree was reported to be compared with postoperative continence status. All operations were done by expert consultants anorectal surgeons in the Colorectal Surgery Unit, El Demerdash Hospital, Ain Shams University and Dar El Shifa Hospital.
Results: This study’s results showed that no preference between staged rerouting procedure and lay open with primary sphincter repair. The former is known to be associated with more recurrence and less incontinence, whereas the latter is associated with less recurrence and more postoperative incontinence.
Conclusion: Both procedures appear to be valid options in the treatment of a high transsphincteric fistula-in-ano with no preference between them, with a low failure rate and acceptable risk of incontinence. Both procedures are challenging, so they should be done by an expert specialized surgeon.
الناسور الشرجي له اثار جانبية على المريض تتراوح بين الألم الطفيف والتجمعات الصديدية والافرازات المزمنة الى التسمم في الدم.
غالبية الناسور الشرجي يتكون من مسار بسيط وحيد يمكن التعرف عليه بسهولة من خلال الفحص الشرجي السريري او اثناء الجراحة بالفحص تحت المخدر, غير انه يتراوح بين خمسة و خمسة عشر في المائة من الحالات يكون فيها مسار أكثر تعقيدا, مع ارتفاع معدل الارتجاع بسبب الأخطاء في تقييم ومعالجة الفتحات الداخلية, أو المسارات الأولية, أو أي امتدادات ثانوية او مخارج ثانوية وعلى الرغم من ان معظم الناسور بسيط ويسهل علاجه, فان بعضها يطرح مشاكل أكبر ويحفز الخوف من التسبب في السلس البرازي وارتجاع الناسور مرة أخرى.
ويعتبر الناسور الشرجي العلوي المخترق للعضلات من التحديات التي تواجه الجراحين, وفي هذه الرسالة نوضح طريقتين للتعامل مع هذا النوع من الناسور وتأثيرهم على نسبة ارتجاع الناسور والعدوى والسلس البرازي. وهما اعادة توجيه مسار الناسور على مرحلتين و استئصال الناسور على مرحلة واحدة مع اعادة اصلاح عضلات الشرج
وأظهرت النتائج ان النسب في مضاعفات الطريقتين متقاربة ويوصى بمزيد من الدراسات المستقبلية مع عدد أكبر من المرضى