Komala, Abhishek Reddy (2016) Assessment of anal incontinence among patients with fistula in ano, at presentation and after seton treatment. Masters thesis, Christian Medical College, Vellore.
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Abstract
INTRODUCTION: Fistula in ano is a tubular tract connecting two epithelial surfaces, connecting mucosa of anal canal to the perianal skin. It is lined by granulation tissue. It can present as a single fistulous tract or as multiple tracts. The actual burden of the disease is unknown because it gets underdiagnosed, misdiagnosed, under reported, treatment is mostly tried by traditional methods. The risk of an anal abscess to lead to fistula in ano ranges from 26% - 38%. Other fistulas caused by subacute infection and suppuration of cryptoglandular glands of anal canal. Rarer causes of fistula in ano include malignancy, tuberculosis, hidradenitis suppurativa and crohn’s disease. Fistula in ano starts as a cryptoglandular abscess which is a representation of acute phase, which the infective stage. This stage significantly affects the quality of life and caused significant amount of discomfort when it forms a big abscess. The correct treatment at this stage itself becomes challenging. Surgery is the treatment of choice to control local sepsis. Goal of therapy at this point is control of local infection, removal of fistulous tract with minimal possibility of recurrence, and preservation of anal sphincters function. OBJECTIVES: 1. To assess prevalence of baseline anal incontinence among new patients presenting with fistula in ano. 2. To determine the incidence of new onset anal incontinence following draining seton surgery for fistula in ano METHODS: A prospective observational study with a sample size of 196 patients who presented with fistula in the department of General Surgery II (Colorectal surgery) during the study period. All the patients had incontinence assessment by Kamm’s scoring and Wexner’s scoring system at presentation in outpatient clinic. They also had anal manometry assessment. The set of patients who had a draining seton surgery done, underwent similar assessment 3 months later to assess continence. RESULTS: 1 - As per Kamm’s scoring system 26.2% patients and according to Wexner’s scoring system 23.5% patients had some form of incontinence at presentation itself. 2 – There was no statistically significant post operative new onset of incontinence following draining seton surgery. CONCLUSIONS: Thus we conclude; 1. As per Kamm’s scoring system 26.2% patients and according to Wexner’s scoring system 23.5% patients had some form of incontinence at presentation itself. 2. Draining Seton surgery is a safe surgery, there was no stastically significant short term (3 monthly) complication was noticed like, anal incontinence. 3. Draining Seton surgery can be done for the patient who present with high fistula in anon. 4. There was no additional risks of developing incontinence based on comorbid illness. 5. Intersphincteric fistulas have low resting anal tone, though trans sphincteric fistulas show drop in squeeze anal tone. 6. There was a basal mild incontinence present in patients with fistula in ano. The severity was more in patients who had multiple perianal surgical procedures. Incontinence was also seen in patients with chronic fistula in ano history. 7. The depth of internal opening and involvement of muscles fibres was also a contributing factor for baseline incontinence Thus it can be concluded safely that there was no significant change of squeeze anal tone following draining seton surgery nor significant change was noted in resting anal tone. Draining seton should be preferred in cases with high fistula in ano in which more than 1/3rd of external anal sphincters are involved.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | anal incontinence ; patients ; fistula ; ano ; presentation ; seton treatment |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 12 Oct 2017 01:04 |
| Last Modified: | 12 Oct 2017 01:04 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/3549 |
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