Fistulotomy and drainage of deep postanal space abscess in the treatment of posterior horseshoe XXXX .

@entity1 @entity322 @entity6 @entity292 @entity733
BACKGROUND: Posterior horseshoe @entity292 with deep postanal space abscess is a complex disease. Most @entity1 have a history of @entity733 or surgery for @entity292 -in-ano. METHODS: Twenty-five @entity1 who underwent surgery for posterior horseshoe @entity292 with deep postanal space abscess were analyzed retrospectively with respect to age, gender, previous surgery for @entity292 -in-ano, number of external openings, diagnostic studies, concordance between preoperative studies and operative findings for the extent of disease, operating time, healing time, complications, and recurrence. RESULTS: There were 22 (88%) @entity1 and 3 (12%) @entity1 with a median age of 37 (range, 25-58) years. The median duration of disease was 13 (range, 3-96) months. There was one external opening in 12 (48%) @entity1 , 2 in 8 (32%), 3 in 4 (16%), and 4 in 1 (4%). Preoperative diagnosis of horseshoe @entity292 was made by contrast fistulography in 4 (16%) @entity1 , by ultrasound in 3 (12%), by magnetic resonance imaging in 6 (24%), and by physical examination only in the remainder (48%). The mean +/- SD operating time was 47 +/- 10 min. The mean +/- SD healing time was 12 +/- 3 weeks. Three of the 25 @entity1 (12%) had @entity6 . Nineteen (76%) @entity1 had undergone previous surgery for @entity292 -in-ano, while five (20%) had only perianal abscess drainage. Neither morbidity nor mortality developed. All @entity1 were followed up for a median of 35 (range, 6-78) months and no recurrence was observed. CONCLUSIONS: Fistulotomy of the tracts along the arms of horseshoe @entity292 and drainage of the deep postanal space abscess with posterior midline incision that severs both the lower edge of the internal sphincter and the subcutaneous external sphincter and divides the superficial external sphincter into halves gives excellent results with no recurrence. When it is necessary, severing the halves of the superficial external sphincter unilaterally or even bilaterally in the same session does not result in anal @entity322 . Close follow-up of @entity1 until the wounds completely healed is essential in the prevention of premature wound closure and recurrence.
