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Updated: Jun 21, 2026
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Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Fistulectomy and sphincteric reconstruction for complex cryptoglandular fistulas
J V Roig1, J García-Armengol, J C Jordán
1Coloproctology Unit, Department of General and Digestive Surgery, Consorcio Hospital General Universitario de Valencia, Valencia, Spain. roig_jvi@gva.es
Summary
Immediate sphincter repair (ISR) may be a viable option for complex anal fistulas (CFs), especially when incontinence is present. While ISR showed a trend towards better fistula healing, it resulted in more postoperative incontinence compared to endoanal advancement flap (EAF).
Area of Science:
- Colorectal surgery
- Anal fistula treatment
- Sphincter repair techniques
Background:
- Complex anal fistulas (CFs) present significant treatment challenges.
- Endoanal advancement flap (EAF) is a standard treatment, but immediate sphincter repair (ISR) after fistulectomy is less common due to incontinence concerns.
Purpose of the Study:
- To compare the efficacy and outcomes of EAF versus ISR for complex anal fistulas.
- To evaluate the impact of both techniques on fistula recurrence and postoperative continence.
Main Methods:
- Retrospective analysis of 146 patients with complex anal fistulas of cryptoglandular origin.
- Patients were divided into two groups: Group A (EAF, n=71) and Group B (ISR, n=75).
- Outcomes assessed included fistula recurrence, preoperative and postoperative continence, and anal sphincter pressures.
Main Results:
- Fistula recurrence rates were 18.3% for EAF and 10.6% for ISR (P=0.19).
- Postoperative continence disturbances were significantly higher in the EAF group (43.6%) compared to the ISR group (21.3%) (P < 0.001).
- EAF surgery led to a significant reduction in maximal anal rest pressure, while ISR did not.
Conclusions:
- Immediate sphincter repair (ISR) can be a therapeutic option for selected complex anal fistula cases, particularly those with preoperative incontinence or risk factors.
- While ISR showed a trend towards lower recurrence, it was associated with a higher incidence of postoperative continence issues compared to EAF.
