Published online Jul 16, 2022. doi: 10.12998/wjcc.v10.i20.6845
Peer-review started: January 14, 2022
First decision: May 10, 2022
Revised: May 12, 2022
Accepted: June 13, 2022
Article in press: June 13, 2022
Published online: July 16, 2022
Certain surgical procedures utilized to treat complex anal fistulas entail partial division of the internal anal sphincter (IAS). The impact of partial division of IAS on continence is not well known.
One of the latest and most effective procedures for complex anal fistulas is the transanal opening of intersphincteric space (TROPIS) procedure which also involves partial incision of the IAS.
The objective was to ascertain the incidence of incontinence after the division of IAS as is done in the TROPIS procedure and to evaluate whether regular Kegel exercises (KE) in the postoperative period can prevent incontinence due to IAS division.
Patients with high complex fistulas who were operated on using the TROPIS procedure were recommended KE for 1 year after surgery. The impact of KE was then evaluated in preventing incontinence after surgery.
Of 102 patients with complex anal fistula who were operated on between July 2018 and July 2020 were included in this study. Overall incontinence occurred in 31% of patients (before doing KE) with urge and gas incontinence accounting for the majority of cases (28.3%). The mean incontinence scores in the patients (before doing KE) were 1.19 ± 1.96. After doing KE regularly, the incontinence remained in only 13% of patients with mean scores decreasing to 0.26 ± 0.77. This improvement in continence was statistically significant (P = 0.00001, t-test).
The partial division of IAS during anal fistula surgery led to incontinence which was mainly urge incontinence and also to a mild degree of gas and liquid incontinence. However, regular KE led to a significant reduction in incontinence.
This study would propel further research to evaluate the importance of KE in preventing incontinence after anal surgery.