A Retrospective Study Of Arcuate Incision And Radical Mastectomy In The Treatment Of Semi-horseshoe-shaped Anal Atrophy

Background:The fistula of semi-horseshoe anal fistula is semi-annular aroud the anal tube in which the internal opening is mostly near the front or back of the anal canal.Surgery is the best method to treat anal fistula.Semi-horseshoe anal fistula has long and bending fistulas,which relatively complicate the process of surgical operations.There is a high risk of anal sphincter function damage during operation.Many cases relapsed after operation.Moreover,it is reported that the complications of pain,wound infection and anal incontinence appeared highly after semi-horseshoe anal fistula operation.The current research on horseshoe fistula mainly focuses on reducing the recurrence rate,protecting the anal morphology and function.Arc-shaped primary radical incision was designed by Professor An A-yue.It is based on the formation mechanism of semi-horseshoe fistula and the form of perianal fistula.It has a significant effect in clinical application in safety,reducing postoperative pain,keeping the drainage unobstructed without damaging the morphology of the anus.Objective:Retrospective analysis was performed to compare the cases of semi-horseshoe fistula treated by arc-shaped primary radical incision with primary incision tunnel-style drainage by analyzing the effective rate,recurrence rate and postoperative anal function.To initially explore the effecy and safety of arc-shaped primary radical incision for semi-horseshoe fistula,and discuss the merit and demerit.Method:It was a retrospective analysis of 51 patients with semi-horseshoe anal fistula from January 2016 to May 2019.According to the different surgical methods,it was divided into two groups,namely arc-shaped primary radical incision group(n=20)and primary incision tunnel-style drainage group(n=31).Inpatient and outpatient medical records,telephone,WeChat and other follow-up visits were used to compare the treatment effect of the two groups.Complications(including postoperative pain,urinary retention,postoperative bleeding),anal finger examination score,Wexner continence score and recurrence were compared between two groups.Results:All patients of two groups were completely wounded.In arc-shaped primary radical incision group,1 case relapsed,and the recurrence rate was 5%.In primary incision tunnel-style drainage group,2 cases relapsed,and the relapse rate was 6.5%.There was no statistical difference between two groups in recurrence rate and effective rate(P>0.05).All recurrence cases in both groups were infections of perianal scars.All healed under incision and drainage.The wound pain in arc-shaped primary radical incision group was lower than that in primary incision tunnel-style drainage group at 3 and 7 days after operation(P<0.05).However,there was no statistically significant difference in the occurrence of other postoperative complications(urinary retention,severe postoperative bleeding,wound infection,anal discomfort,defecation disorder)(P>0.05).There was no statistical difference in hospitalization time and wound healing time between the two groups(P>0.05).There was no statistically significant difference in the anal finger examination score between the two groups before and after the self-control,and between the groups before and after the operation(P>0.05).There was no significant difference in Wexner continence score between the two groups during the follow-up visit(P>0.05).Conclusion:The efficacy,safety,incidence rate of postoperative complications were similar between two groups.Moreover,arc-shaped primary radical incision had the advantage of primary incision tunnel-style drainage in reducing pain.As for arc-shaped primary radical incision,fistulas are opened along the texture of the muscle,which causes less damage to the normal tissues around the anus and benefit for drainage.Thoroughly open the fistulas reduced the difficulty of dressing change,which also avoid extra pain during dressing change.The form of scars after healing are linear,avoiding the anal deformity caused by scar contracture.Arc-shaped primary radical incision was definitely effective and safe in treating semi-horseshoe fistula,and caused no damage to anal function and morphology.It is an ideal method for the treatment of semi-horseshoe fistula,but randomized controlled trials and large long-term follow-up studies are needed.