Muscle-filling procedure for transsphincteric fistulas.

PURPOSE: During transsphincteric fistula surgery, laying open the entire fistula track can cause grave damage. Thus, a surgical procedure that excises the primary abscess only is preferable. However, the primary abscess of a transsphincteric fistula is located in the postanal space. When creating an appropriate drainage wound after excision of the primary abscess, damage to the drainage wound itself can be severe. This article illustrates an alternative procedure. METHODS: We have developed a new method in which we excise only the primary abscess of a transsphincteric fistula and use the muscle flap at the bottom of the wound to fill in the dead space left by the excision. This procedure takes advantage of the availability of the muscle flap and allows for a smaller wound and faster wound healing. RESULTS: During the past 17 years, during which 328 transsphincteric fistula procedures have been performed using the muscle-filling technique, we have experienced a recurrence rate of only 1.5 percent (5 cases). CONCLUSION: The muscle-filling technique is an effective alternative procedure for transsphincteric fistulas.

[Problems in the Japanese general rules for studies on cancer of the colon, rectum and anus and TNM classification and follow-up studies].

Five-year survival rate of the anal cancer on stage classification has been analyzed using Japanese Research Society (J.R.S.) and TNM classification. On studying of 73 consecutive patients who had abdominoperineal resection of the rectum for anal cancer at the Health Insurance Central Hospital, Tokyo, 5-year survival rate of stage II was lower than that of stage III in the J.R.S. while appropriate distribution of survival rate was seen in the TNM classification. On the anal cancer, size or rate of infiltration to circumference of the anal canal of the tumor has an important effect on prognosis. We recommend to add infiltration to circumference of the anal canal as a factor on the stage classification.