Efficacy of naked external anal sphincter surgery in the treatment of horseshoe shaped anal fistula and its impact on the risk of recurrence
10.3760/cma.j.cn115396-20241206-00374
- VernacularTitle:肛门外括约肌裸化术治疗马蹄形肛瘘的疗效及对复发风险的影响
- Author:
Min ZHAO
1
;
Jiagang HAN
Author Information
1. 北京大学第三医院延庆医院普外科，北京 102100
- Keywords:
Recurrence;
Risk factors;
Retrospective study;
Anal fistula
- From:
International Journal of Surgery
2025;52(5):313-318
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the clinical efficacy of naked anal sphincter surgery for the treatment of horseshoe shaped anal fistula, and analyze the risk factors affecting postoperative recurrence of horseshoe shaped anal fistula.Methods:A retrospective controlled analysis was conducted on the medical records of 103 patients with horseshoe anal fistula who were treated at Yanqing Hospital of Peking University Third Hospital from May 2021 to June 2023. Among them, there were 69 males and 34 females, with an age ranging from 35 to 51 years old, and the average age was (43.21±3.04) years old. According to the surgical methods, they were divided into the traditional surgery group ( n=51) and the external anal sphincter denudation group ( n=52). The traditional surgery group was treated with the traditional Hanley operation, and the patients in the external anal sphincter denudation group were given the external anal sphincter denudation operation. The clinical related indicators and anal function of the two groups of patients were compared. The patients were followed up for 1 year after the operation to observe the recurrence situation. The statistical analysis was carried out using SPSS 22.0 software. The measurement data conforming to the normal distribution were expressed as mean ± standard deviation ( ± s), and the independent sample t-test was used for the comparison between groups; non-normal distribution data were expressed as [ M( Q1, Q3)], and the comparison between groups was conducted using Mann-Whitney U test. Multivariate Logistic regression analysis was applied for the analysis of risk factors. Results:Compared with the traditional surgery group, the operation time[(29.35±1.22) min vs(33.48±0.98) min, t=18.92, P<0.001], wound healing time[(25.14±3.11) d vs(28.29±3.65) d, t=4.71, P<0.001], and hospital stay [(8.65±1.11) d vs (11.04±2.02) d, t=7.42, P<0.001] in the external anal sphincter denudation group were all shorter, and the intraoperative blood loss was less[(15.64±2.20) mL vs (20.39±1.98) mL, t=11.52, P<0.001]. The anal function was improved at 1 month, 3 months, and 1 year after the operation ( P<0.05). One year after the operation, the patients were divided into a recurrence group ( n=19) and a non-recurrence group ( n=84) according to whether there was a recurrence. Multivariate Logistic regression analysis showed that diabetes ( OR=4.426, 95% CI: 1.025-19.116) and a high incidence of postoperative complications ( OR=9.955, 95% CI: 2.705-36.632) were independent risk factors for the recurrence after horseshoe anal fistula surgery; treatment with external anal sphincter denudation ( OR=0.149, 95% CI: 0.034-0.659) was an independent protective factor against the recurrence after horseshoe anal fistula surgery. Conclusion:Anal sphincter denudation surgery effectively promotes postoperative recovery in patients with horseshoe anal fistula, enhances anal function, and reduces the risk of recurrence.
