豊永敬之の複雑痔瘻・深部痔瘻に対する痔瘻根治手術・括約筋温存手術・瘻管切開手術の論文 of 福岡の大腸・肛門科専門医による痔・肛門科・大腸内視鏡（大腸カメラ）のサイト　大腸肛門武者修行

Purpose: This study compared the clinical and physiological results of non sphincter splitting fistulectomy (N-SSF) with those of sphincter splitting fistulotomy (SSF) for treatment of high trans-sphincteric fistula-in-ano.
Methods: A prospective, observational study was undertaken in 70 consecutive patients with high trans-sphincteric fistula treated by SSF (n = 35) or N-SSF (n = 35). Anal manometry was performed before and 3 months after surgery. Anal continence was assessed using Cleveland Clinic Florida Incontinence Score.
Results: There was no difference between the two groups in age, gender, presence of horseshoe extension, preoperative incontinence score and manometric values. The incidence of recurrence was similar between the two groups. The postoperative incontinence score of SSF group was significantly higher than that of N-SSF group (1.9 ± 2.9 versus 1.1 ± 2.9, P = 0.0347). Maximum resting pressure showed significant decrease after surgery in both groups (83.2 to 56.1 mmHg, P = 0.0001, and 85.1 to 58.4 mmHg, P = 0.0001). Voluntary contraction pressure and functional anal canal length did not change after N-SSF (137.6 to 138.2 mmHg, P = 0.9524, and 4.06 to 4.07 cm, P = 0.9524) but significantly decreased after SSF (120.2 to 96.7 mmHg, P = 0.0085, and 4.12 to 3.74 cm, P = 0.0183).
Conclusion: Non sphincter splitting fistulectomy for high trans-sphincteric fistula provided better functional results than fistulotomy. Less impairment of anal continence was achieved possibly not only by maintenance of the external anal sphincter function but also by preservation the length of the high pressure zone.