Surgery for Perianal Fistula while Conserving Anal Function

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  • VI．肛門機能障害を考慮した痔瘻手術

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Surgery for perianal fistula cannot avoid invasion of the anal sphincter muscle. It is required to achieve both conservation of anal function and curability. The methods are classified into the lay-open method, sphincter-preserving method, and seton method. Though the lay-open method has an advantage in curability, it has a high risk of anal dysfunction. The anal sphincter-preserving method might effectively maintain anal function, but is followed by a higher rate of recurrence. Seton is a well-balanced method that satisfies both curability and conservation of anal function but it requires a longer period to cure. It is important to consider the state of the disease and the wishes of the patient when performing surgery for perianal fistula to achieve high curability, low incidence of anal dysfunction and early recovery. Anal dysfunction may occur after inappropriate sphincterotomy, and impairs the patient's quality of life by causing fecal incontinence and soiling. The first choice in cases with anal incontinence is bowel control and training of the sphincter muscle. If this fails, surgery such as sphincter repair and posterior sphincteroplasty could be effective. Surgery without postoperative complaints is expected for perianal fistula, as a benign disease.

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