TREATMENT OF ISCHIORECTAL ANAL FISTULA (ANO‐RECTAL FISTULA)

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Abstract
Summary: 1. A series of 24 patients with an ischiorectal anal fistula (ano‐rectal fistula) were subjected to operation.2. In 20, the fistula was classified as a posterior ischiorectal anal fistula because the internal opening was situated in the middle line posteriorly. The fistulous track ran in the ischiorectal fossa either on one or on both sides. An external opening was present in 18 and absent in two. Secondary tracks in the peri‐anal and supra‐levator spaces were sometimes present.3. In three patients the fistula was classified as an anterior ischiorectal anal fistula because the internal opening was in the middle line anteriorly.4. In one case no internal opening was found. It was the first case in the series.5. In 22 of the 24 cases of this series the fistula was treated by a one‐stage operation in which the whole track was laid open and the resulting wound covered by a primary skin graft. In one case the wound was too vascular and the graft deferred for two days whilst in the other‐case no graft was applied because of the desire to have the patient out of bed to void within a few hours of the operation.6. Despite the long operation there has been no operative or post‐operative mortality.7. In 20 cases, 90 per cent, or more of the graft was successful and the wound almost healed within 7 to 10 days of the operation. In the remaining three cases part or whole of a sheet of skin failed either because of haematoma formation or because it had been displaced during the application of the dressings. In the least successful result there was approximately a 50 per cent. “take.”8. Therc was only one recurrence; this was in the first case of the series in which an internal opening was not discovered.9. All patients were continent, although for a week or two after the operation there was a tendency for the sphincteric function to be inadequate. In 22 patients the sphinctcr muscle seemed as strong to the patient as it did before the operation. In the othcr two, there was some weakness when the motions became loose.10. In three patients there was a small, symptomless partial mucosal prolapse.11. The deformity produced by laying open and skin grafting this large fistula has not been a cause for complaint by any patient.

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