Two Stages Re-routing Versus Fistulectomy with Primary Sphincteric Reconstruction in Treatment of High Transsphincteric Anal Fistula

Document Type : Original Article

Authors

Department of General Surgery, Faculty of Medicine, Sohag University, Egypt

Abstract

Background: Fistula in ano remains a challenging condition in colorectal surgery due to its high recurrence rate and
potential for fecal incontinence. Various surgical techniques, such as seton placement, fibrin glue application, rectal
advancement flaps, collagen plug insertion, fistulotomy with sphincter repair and fistula tract rerouting, have been
described for its treatment. Nonetheless, no single technique consistently superior to the others. Obliterating the fistula
tract while maintaining complete continence is the main objective of any therapeutic strategy.
Objective: The outcomes of rerouting and fistulectomy with primary sphincteric reconstruction will be analyzed and
compared in order to ascertain which procedure is better for treating high trans-sphincteric fistulas in ano.
Patients and Methods: A randomized clinical trial was conducted between January 2023 and May 2024, involving 30
patients with high trans-sphincteric fistulas. Patients were randomized to either the fistulectomy and primary sphincteric
repair group or the rerouting group.
Results: Both groups exhibited similar results, with no statistically significant difference observed between them regarding
the recurrence rate, postoperative complications and continence.
Conclusion: In patients with high trans-sphincteric fistula-in ano, rerouting and fistulectomy with primary sphincteric
reconstruction operations yield similar results in terms of healing rate, recurrence, continence, and quality of life; no
treatment is better than the other.

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