Surgical treatment of patients with postoperative perianal scar deformities and concurrent rectal fistulas

Abstract

Perianal scar deformity is referred to as a scar or deformity in the perianal area, with or without extension to the anal canal. It frequently occurs after surgical treatment for acute purulent necrotic diseases and is associated with the formation of fistulas in the scar.

Objective —  to evaluate the experience of the proctology department in the treatment of postoperative perianal scar deformities and concurrent rectal fistulas using one‑stage combined plastic surgery.

Materials and methods. A prospective, non‑randomized study was carried out at the proctology department of the Kyiv City Clinical Hospital No. 18 to evaluate the treatment outcomes for postoperative perianal scar deformities and concurrent fistulas in the scar using one‑stage combined plastic surgery. A total of 34 patients were treated from January 2021 to February 2023, with an average age of 41.85±7.81 years. All patients had a history of surgical treatment of purulent‑necrotic perineal diseases. The observation period ranged from 1 to 6 months. Preoperative and postoperative data were collected to analyze the duration of surgery, the incidence of complications, the duration of hospitalization and rehabilitation.

Results. All 34 patients underwent one‑stage combined plastic surgery, which included a combination of anoplasty or sphincteroplasty and flap plastic surgery. The size of the scar deformity was important when choosing a wound closure method, as 3 (8.82%) patients had a small lesion (up to 2 cm²), 20 (58.82%) had a moderate lesion (from 2 to 6 cm²), and 11 (32.36%) had a widespread lesion of the perianal area (more than 6 cm²). The type of rectal fistula was also taken into account: a simple fistula was observed in 26 (76.47%) patients, and a complex fistula in 8 (23.53%). The average duration of the operation was 90.41±13.48 min, and the patient’s hospitalization period was 5.88±1.41 days. Postoperative complications were observed in 3 patients (8.82%).

Conclusions. Our findings demonstrate that, in the majority of patients, a single‑stage excision of postoperative perianal scar deformities and concurrent fistulas combined with skin grafting allows for the preservation of normal anal function and satisfactory cosmetic and functional outcomes.