Rerouting as a minimal sphincter sacrificing procedure for the management of horseshoe perianal fistula: a prospective observational study

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Abstract

Back
ground Horseshoe fistula is a complex and challenging type of fistula due to the depth and complexity of its associated fistulous track. High rates of recurrence and incontinence after surgical treatment are the dominant issues surrounding the management of this disease.
Aim of the study
The aim of the present study is to assess the feasibility and results of the use of rerouting technique, which the authors previously described in the treatment of simpler fistulas, for the management of the more complex horseshoe fistula.
Patients and methods
This is a prospective, observational study in which 30 patients with horseshoe fistula were operated upon by the staged rerouting operation. Patients were recruited from El Demerdash University Hospital, and Dar Elshefa Hospital, Cairo, Egypt. The operation was completed in three stages: in stage one, all extrasphincteric tracks, including the horseshoe track, were laid open and a seton was left in the main transsphincteric track. In the second stage, the transsphincteric track was rerouted into the intersphincteric space, and in the third stage, fistulotomy of the intersphincteric fistula was done. Twenty-three patients completed all stages of the procedure and were the participants of the present study.
Results
After a minimum follow-up of 7 months, three patients (13%) developed minimal incontinence (Wexner score 2), and none of the patients had fistula recurrence.
Conclusion
Staged fistulotomy for horseshoe fistula with rerouting of the transsphincteric track into intersphincteric position is associated with acceptable results as regards recurrence and incontinence.

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