THE LIGATION OF THE INTERSPHINETRIC TRACT PROCEDURE OF THE PERIANAL FISTULA: CASE REPORT

Perianal fistula is usually of cryptoglandular origin, namely it results from inflammation of the anal glands. The main challenge in its management is how to resolve a fistula but avoid its recurrence as well as incontinence, which is even a bigger problem. Several treatment methods have been described and they all focus on cutting the anal sphincter and "opening" the fistula, placing the seton, plug technique, creating a mucosal advancement flap, injecting medical occlusive agents or using a combination of methods. In 2007 a method of managing a fistula by ligation of the intersphincteric fistula tract was described. The procedure is still getting a wider application.

A 60-year old male patient had had a fistula for 30 years. He underwent incision of perianal abscess on multiple occasions resulting in multiple scars in the gluteus area. The diagnosis revealed a high transsphincteric fistula. The inner ostium was diagnosed by injecting hydrogen-peroxide and by probing. The patient's general condition was satisfactory. For the first time the ligation of intersphincteric fistula tract procedure was applied in our regional hospital. Under general anesthesia, in a lithotomy position, the ligation of intersphincteric fistula tract procedure was successfully performed in approximately 30 minutes. The external opening of the fistula and the scars were widely excised. The postoperative course was uneventful. After 6 months there was no recurrence.

The ligation of intersphincteric fistula tract procedure for transsphincteric fistulae can be a treatment of choice in all hospitals treating colorectal patients because the incontinence risk is low, and the disease is curable at a high percentage.