Sphincter-Preserving Fistulectomy Is an Effective Minimally Invasive Technique for Complex Anal Fistulas

Abstract

BackgroundThe optimal treatment of complex anal fistulas remains unclear, though many different sphincter-preserving procedures have been described. A minimally invasive technique with a better outcome is desired. The purpose of this study was to present a new technique—sphincter-preserving fistulectomy (SPF) and its clinical outcomes.Materials and MethodsA retrospective study was performed to compare the efficacy and outcomes of SPF with ligation of the intersphincteric fistula tract (LIFT) in the management of complex anal fistulas in regards to postoperative pain, complications, wound healing time, recurrence, overall success rate, fecal continence function, and quality of life. Continence function was evaluated using the Wexner incontinence scale and anal manometry. The fecal incontinence quality of life (FIQL) scale was used to assess patients' quality of life.ResultsFrom June 2020 to July 2021, 41 patients with 43 SPF procedures and 35 patients with 35 LIFT procedures were included. Postoperative pain was comparable between two groups. The morbidity rate and the mean wound healing time in the SPF group were lower than those in the LIFT group (2.3% vs. 48.6%, p < 0.001; 1.4 ± 0.3 vs. 1.7 ± 0.4 months, p = 0.001). At a mean follow-up duration of 11.4 ± 3.5 months in the SPF group and 10.7 ± 4.3 months in the LIFT group, SPF achieved a better overall success rate than LIFT (97.7% vs. 77.1%, p = 0.014). Three patients in the SPF group and 4 patients in the LIFT group who all underwent a simultaneous fistulotomy procedure complained new incontinence of flatus. There was no statistical difference between the two groups in regards to the Wexner scores (p = 0.790), the maximum resting anal canal pressure (p = 0.641), the maximum squeeze pressure (p = 0.289), and the FIQL scores including lifestyle (p = 0.188), coping (p = 0.188), depression (p = 0.850), and embarrassment (p = 0.910).ConclusionsSPF is a novel, safe, and effective minimally invasive technique for the management of complex anal fistulas, with a promising success rate and negligible impairment on continence. Future prospective studies are needed to evaluate the long-term outcomes of SPF.

Efficacy and safety of 13 surgical techniques for the treatment of complex anal fistula, non-Crohn CAF: a systematic review and network meta-analysis

“…37 reported ʻ0ʼ, while Su et al .’s study missed the data on recurrence 25 . FSR is one surgical method combining fistulotomy and sphincter reconstruction by excising the fistula tract and repairing the internal and external anal sphincter 13 . The recurrence rate and complication rate of FSR were reported at 7.1 and 32.1% in a study conducted by Perez et al .…”

“…Considering the difficulty of the treatment of CAF, there are various kinds of surgical techniques in the clinical work, such as ligation of intersphincteric fistula tract (LIFT) 9 , endoanal advancement flap repair (EAFR) 10 , video-assisted anal fistule treatment(VAAFT) 11 , seton 12 , fistulectomy 13 , fistulotomy 14 , anal fistula plug (AFP) 15 , fistulotomy plus seton (FPS) or incision thread drawing 16 , LIFT-plug 17 , fistulotomy with sphincter reconstruction (FSR) 18 , video-assisted modified ligation of the intersphincteric fistula tract (VAMLIFT) 11 , tunnel-like fistulectomy plus draining seton combined with incision of the internal opening of anal fistula (TFSIA) 16 , and LIFT+ EAFR. However, none of these surgical methods are ideal.…”

Comparison of clinical outcomes of anal fistula plug and endoanal advancement flap repair treating the complex anal fistula: a systematic review and meta-analysis

“…The treatment of a complex anal fistula is a hard nut to crack [ 30 ]. Although there are many kinds of surgical techniques in the medical field such as LIFT, EAFR, VAAFT, Thread-drawing, Fistulectomy, Fistulotomy, AFP, Incision and thread-ligating, LIFT-plug et al, it can be reasoned out that none of the operations is ideal [ 31 ]. However, we have to choose one better technique that meets the patients’ needs.…”