Recommended Treatment for Ischiorectal and Supralevator Fistula

In the past, the same fistulotomy (lay-open procedure) used to treat intersphincteric fistula was also used to treat ischiorectal fistula and supralevator fistula. However, when the lay-open procedure was performed on ischiorectal fistula and supralevator fistula there was a possibility that the rectum would shift forward and the number of postoperative in-continence cases would increase. When anal function was manometrically examined after the lay-open procedure was performed on low intersphincteric fistula there was a significant reduction in the maximum resting pressure of the lateral lay-open procedure compared to the posterior lay-open procedure. Moreover, the results of a questionnaire to ascertain the degree of anal sphincter tension one year after the lay-open procedure was performed on the anterior, lateral and posterior sides of the low intersphincteric fistula revealed that 24.3 ％ of the anterior cases, 54.9 ％ of the lateral cases, and 16.4 ％ of the posterior cases reported low tension. In other words, sphincter function was greatly influenced when an anal sphincter-otomy was performed. Judging from these results, even with the Hanley technique, there is a strong possibility of impairing sphincter function when the lay-open procedure is performed from a posterior lesion to the primary orifice on the dentate line. Therefore, the sphincter-preserving surgical procedure is recommended for ischiorectal fistula and supralevator