The use of rerouting operation in the treatment of high arching transsphincteric and suprasphincteric anal fistula: an observational study

Background
Perianal fistula is a common disease that has no medical treatment, and cure is only achieved by surgery. Fistulotomy is associated with minimal recurrence; however, incontinence is not uncommonly reported. Many sphincter-saving procedures can avoid fecal incontinence; however, they are associated with significantly higher recurrence. Anal fistula rerouting, described in 1985, entailed staged transposition of the fistulous track to the intersphincteric or submucous space, after which fistulotomy was done. Apparently, minimal recurrence and minimal incontinence could be achieved; however, the operation did not gain much popularity.
Patients and methods
This prospective study reports the results of rerouting operation in 54 (45 males; age 22–69 years) with high arching transsphincteric and suprasphincteric fistulae. All patients underwent two-stage rerouting operation: in stage I, the track was transposed to the intersphincteric space, and in stage II, the intersphincteric fistula was laid open. Main outcome measures were as follows: continence was assessed using Wexner score after complete healing of the first-stage and second-stage wounds, and every 3 months thereafter for 1 year. Recurrence was defined as persistent purulent discharge from an external opening or from the anal canal. The least follow-up was 9 months.
Results
Three (5.5%) patients had recurrence; two were treated by fistulotomy and the other refused further intervention. Four (7.4%) patients had minor incontinence. One patient developed track gangrene that was treated by track excision and completed staged rerouting successfully.
Conclusions
Rerouting operation for high arching transsphincteric and suprasphincteric fistulae is associated with low recurrence and minimal incontinence.