Ligation of intersphincteric fistula tract for complex anorectal fistulas with initial promising results

Background
The aim of anal fistula treatment is to cure the disease without any risk for fecal incontinence. Surgery for treating anal fistulas can be divided into two types: sphincter-sacrificing and sphincter-saving methods. There are many sphincter-saving operations such as ligation of the intersphincteric fistula tract, application of fibrin glue, endorectal advancement flap, and video-assisted fistula surgery.
Objective
The aim of this study was to evaluate the effectiveness of intersphincteric ligation of the fistulous tract in the management of complex anal fistula.
Design
Study of patients with complex anal fistulas was done prospectively from 1 September 2013 to 31 January 2015. Patients’ data, fistula type determined by magnetic resonance imaging, continence scales before and after surgery, previous surgery, healing rates, recurrence rates, re-do in recurrent cases, and complications were recorded.
Settings
The study was conducted at a single tertiary care institution.
Patients
Eighteen patients were included.
Main outcome measures
These included recurrences, surgical time, complications, and fecal incontinence.
Results
The study included 18 patients. Two patients were female and 16 were male. The mean age was 35.55 ± 9.89. The median wound-healing time was 2.44 weeks. Of the 18 patients, 16 (88.9%) had complete healing of the fistula. None of the patients developed fecal incontinence.
Conclusion
Ligation of the intersphincteric fistulous tract is an effective technique for treatment of anal fistula. It is also a good option for maintaining continence and sphincter saving in the management of fistula-in-ano.
Study limitations
The small number of patients and the short follow-up period are the major limitations of this study.