For many high anal fistulas, lay open is still a good option

Abstract

Lay open of low and high anal fistulas is effective and associated with a similar, predictable rate of minor sphincter disturbance, amounting to a third to one quarter of patients with mild leakage of flatus and mucus. Patients with high fistulas can be cured, but when a surgeon is in doubt, a second opinion at an expert centre should be sought before definitive intervention.

Video-assisted anal fistula treatment (VAAFT): a novel sphincter-saving procedure for treating complex anal fistulas

“…Recently, Phillips et al reported that the lay open technique is still a good option for the management of such complex anal fistulas. Ninety-six per cent of their patients healed and the incidence rates of incontinence for flatus, soft stools and hard stools were 30, 2 and 4%, respectively, with only 8% of patients obliged to use a pad [4]. Over the last few years, many novel attempts have been made to treat complex anal fistulas with minimally invasive techniques including ligation of the intersphincteric fistula tract (the LIFT procedure), anal fistula plugs and the utilization of commercially available fibrin glues [5–7].…”

Ligation of the intersphincteric fistula tract in low transsphincteric fistulae: a new technique to avoid fistulotomy

“…Atkin et al. [20] found no difference in the operation‐induced continence disturbances after division of the internal anal sphincter alone during fistulotomy for intersphincteric fistulae compared with division of the lower part of both anal sphincters in patients with a transsphincteric fistula. In contrast to this finding, Garcia‐Aguilar et al.…”

Closure of Fistula Tract With Filac™ Laser As a Sphincter Preserving Method in Anal Fistula Treatment

“…10,11 Fistülotomi ile "yüksek" bir fistül tedavi ederken artan endişe, fistülün seviyesinin yükselmesiyle birlikte cerrahi tedavi sırasında oluşabilecek anal sfinkter hasarına bağlı kontinansın bozulması riskidir. 12 Bu nedenle, tedavi amaçlı fistül cerrahisinde fonksiyonel ikilemi en aza indirgemek için fibrin tutkalı (fibrin glue), anal fistül tıkacı, anorektal ilerleme flebi ve intersfinkterik fistül traktı ligasyonu (LİFT) içeren çeşitli "sfinkter koruyucu" teknikler tanımlanmıştır.…”