痔ろうに対する一次口の閉鎖または切除の効果

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  • EFFECTS OF CLOSURE OR EXCISION OF THE PRIMARY OPENING FOR ANAL FISTULA AND PERIANAL ABSCESS

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The purpose of this study was to examine the effects of closure or excision of the primary opening on recurrence of inflammation in the treatment of anal fistula and perianal abscess.<br>Subjects were 67 patients with anal fistula and 11 patients with perianal abscess who entered the study after we obtained their informed consent to the operation. Patients with anal fistula underwent either of the following two operative procedures: a closure of the primary opening by suture under spinal anesthesia; and an excision of the primary opening with a closure of a fistulous duct penetrating the internal sphincter muscle of anus by suture under spinal anesthesia. A closure of the primary opening by suture and an incision of abscess were applied for patients with perianal abscess.<br>Their clinical courses were followed for 8-60 months, with a mean of 21 months. As for anal fistula, recurrence of inflammation was observed in three (7.7%) out of 39 patients undergoing a closure of the primary opening, and in one (3.6%) out of 28 patients undergoing an excision of the primary opening. As for perianal abscess, recurrence occurred in 10 (91%) out of 11 patients.<br>It is concluded that either operative procedure is ineffective for anal fistula with severe inflammation including abscess formation; and that a closure of the primary opening is beneficial for low anal fistula with mild inflammation and an excision of the primary opening for high anal fistula.

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