The Clinical Research Of Therapy For High Fistula By Sneak Removal Under Endoscopic And Closed Drainage

Background:Currently it’s quite difficult to find a proper treatment for high-type anal fistula, especially for complex high-type anal fistula, because the operation involves anal function and the lumen extends in a large area. The treatment for high-type anal fistula is difficult, with high recurrence rate, and there are many complications and sequela. So it’s also referred to as difficult anal fistula by experts both domestic and abroad. There are many treatments such as incision and drainage, thread drainage operation, duct drainage, biological dressings in open abdomen. Generally speaking, such treatments are satisfying, but still with issues like slow recovery, severe pain, insufficient protection of sphincter function, and high recurrence rate. In order to cure high-type anal fistula and to achieve best protection of anal function, we designed a minimally invasive surgery of sneak removal (internal opening removal or truncation) with ultrasonic scalpel under endoscope, closing the wound with the vacuum sealing drainage technology, to retain the function and shape of anus as far as possible, so that the patient is able to live a better life and the course can be shortened.Objective:To prevent problems caused by current treatment for high-type anal fistula. To retain the shape and function of anus and to prevent pain caused by open wound as far as possible while curing the fistula, so that the wound could close faster and the patient would live a better life.Methods:30patients with high-type anal fistula as required are chosen and assigned into treatment group and control group, both of which has15patients. Treatment group are treated with sneak removal and closed drainage under endoscope; control group are treated with incision and drainage surgery. After the surgery, the efficacy of treatment, time of wound closure, pain scores, anal function evaluation, recurrence rate in two groups are compared.Results:There’s no significant statistical difference (P>0.05) between treatment group and control group in age, gender, course, total efficacy, recurrence rate. After the treatment, there are significant difference (P<0.05) between two groups in length of stay and wound healing time, pain scores, determination of the anal canal pressure, anal function DRE and anal incontinence score (Wexner).Conclusion:Sneak removal under endoscope with closed drainage is effective in treating high-type anal fistula, which is better as it’s minimally invasive, with less pain and fast recovery, and retain the anal function as far as possible.