Transanal Opening Of Intersphincteric Space And Loose Seton Drainage For Complex Anal Fistula:A Prospective Cohort Study

Objective: Objective to investigate the clinical effect of transanal opening of intersphincteric space and loose seton drainage for complex anal fistula and its influence on anal function and quality of life.Methods: From March 2020 to August 2020,a prospective cohort study was conducted to select the patients who underwent complex anal fistula surgery in our department.According to different surgical methods,the patients were divided into exposure group and control group.The patients who received inter anal sphincterotomy and relaxation thread drawing drainage were as exposure group,and the patients who received anal fistula incision and thread drawing were as control group.There were 33 cases in each group,with a total of 66 cases.The clinical efficacy,anal function,quality of life,postoperative complications and recurrence rate of the two groups were compared.The severity of fecal incontinence(Wexner score)was used to assess the effects of anal function.The quality of life(FIQo L)score was assessed to assess the quality of life.Pain analogue scale(VAS)was used to evaluate postoperative pain.The postoperative complications such as urinary retention,wound infection,anal deformability,anal exudate,anal oozing and healing time were compared between the two groups.There was no recurrence after operation.The patients were followed up for 6 months by outpatient,questionnaire and telephone to understand the wound healing,anal continence,quality of life and recurrence.Results: A total of 66 patients were included in this study,33 cases in each group.After the completion of the experiment,2 cases in the exposure group did not complete the follow-up,and 1 case in the control group lost the follow-up.Finally,63 patients who met the research conditions were selected,including 31 cases in the exposure group and 32 cases in the control group.In the exposure group,there were 5 cases with a history of anal fistula surgery,2cases with a history of anal fistula surgery,3 cases with a history of anal fistula surgery,and 4 cases with a history of anal fistula surgery.After statistical analysis,there was no significant difference in gender,age,course of disease and other baseline characteristics between the two groups(P > 0.05).There was no significant difference in the preoperative Wexner score,fiqol score and VAS score between the two groups(P > 0.05).The Wexner scores of the exposure group at 1 month,3 months and 6 months after operation were significantly lower than those of the control group(P < 0.05).The fiqol scores of the exposure group at 1 month,3 months and 6 months after operation were better than those of the control group in terms of lifestyle and embarrassment(P <0.05).There was no significant difference in coping / behavior and depression /self perception between the two groups at each time point after operation(P >0.05).There was no significant difference between the two groups(P > 0.05).The VAS scores of the exposure group on the day,the first day,the third day and the seventh day after operation were lower than those of the control group(P < 0.05),and there was no significant difference between the two groups on the 15 th day after operation(P > 0.05).There was no significant difference in the total postoperative complications between the two groups(P > 0.05),but the cases of anal deformation,anal exudation and fecal leakage in the control group were significantly higher than those in the exposure group.The wound healing time of the two groups was about 30 days,and there was no significant difference(P > 0.05).There was no significant difference in the one-time cure rate,effective rate,inefficiency and recurrence rate between the two groups(P> 0.05).The one-time cure rate of the exposure group was 87.1%,while that of the control group was 90.6%,and the difference was not statistically significant(P > 0.05).Conclusion: The treatment of complex anal fistula by intersphincteric incision relaxation thread drawing drainage and anal fistula incision thread drawing has the same curative effect.It has little impact on anal function and quality of life.The anal function is well protected,which improves the postoperative quality of life of patients.It provides a new research idea for the protection of anal function,provides another choice for clinical sphincter preserving surgery in the treatment of complex anal fistula,and provides a practical basis for clinical application.