| Objective To compare the clinical efficacy of anatomical segmental ligation versus conventional incisional ligation for thetreatment of high horseshoe anal fistulae during long-term follow-up.Methods In this prospective controlled study, 86 patients with high-grade horseshoe anal fistulas who underwent surgical treatment at the Department of Anus and Intestines, Shuguang Hospital,Shanghai University of Traditional Chinese Medicine, from March 2019 to June 2020 were selected and divided into a treatment group(anatomical segmental ligation group, n=43) and a control group (conventional incisional ligation group, n=43) based on a randomized numerical table. The follow-up period ranged from 31 to 44 months (median follow-up period 36 months), and the differences betweenthe two groups were compared in terms of intraoperative and postoperative complications, wound healing and recurrence, and healtheconomic indicators.Results There was no significant difference in the general information of the patients in the two groups, the histo-ry of previous surgery or the anatomical characteristics of the anal fistula (anal fistula type, internal orifice, etc.) (P>0.05). The cure rateof the treatment group was 86% (37/43), higher than that of the control group (76.7%, 33/43), but the difference was not statistically sig-nificant (P>0.05). Intraoperative bleeding in the treatment group was 15 (15, 20), mL less than 20 (20, 25) mL in the control group (P< 0.05); postoperative pain scores [visual analog scale (VAS) scores] and severity of anal incontinence (Wexner) scores in the treatment group were 2 (0,3) and 0 (0, 0), respectively, which were greater than those in the control group (P < 0.05); the operation time, hospital-ization time and wound healing time of the treatment group were 27.67±4.85 min, 6 (4, 7) d and 6.78±2.00 weeks, respectively, whichwere significantly less than those in the control group [32.67±7.27 min, 7 (6, 10) d, and 8.10±2.12 weeks, respectively] (all P < 0.05). Conclusions Anatomical segmental ligation can effectively cure high horseshoe anal fistulas. Compared with conventional incisionalligation, anatomical segmental ligation for high horseshoe anal fistulas has the advantages of protecting anal function, reducing intraop-erative and postoperative complications, and shortening wound healing time and hospitalization time, and it is a safe and effective typeof anal sphincter protection surgery. |
