High Ligation of the Fistula Track by Lateral Approach: A Modified Sphincter-Saving Technique for Advanced Anal Fistulas

Abstract

Aim:  Ligation of the intersphincteric fistula track is a novel surgical procedure with the advantage of avoiding anal incontinence. We conducted a preliminary investigation of a modified technique for complicated transsphincteric anal fistula by high ligation of the track using a lateral approach.

Method:  From June 2010 through May 2011, ten patients received high ligation of the fistula track by lateral approach. Patients selected for the procedure had a mature transsphincteric type of anal fistula that involved a significant amount of the external sphincter. Cases with early fistulous abscess or with a history of previous anal surgery were excluded. The surgical technique involved making an incision from the external opening and extending this towards the direction of the internal opening, dissection of the fistula from underlying soft tissue, high ligation above the internal sphincter, and removal of the distal part of the fistula track for pathological examination.

Results:  Of the 10 patients, 8 were men and the mean age was 40.5 years (SD±7.23). The median duration of follow-up was 7 (6–10) months. In all patients, the wound was completely healed by the sixth postoperative week. Two cases of recurrence were noted later and successfully managed by traditional fistulotomy.

Conclusion:  High ligation of the fistula track for the transsphincteric anal fistula surgery aimed at total anal sphincter preservation has shown encouraging early results. Long-term follow-up and randomized controlled trials are necessary.

© 2012 The Authors Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland