Closure of the internal opening for treatment of complex fistula-in-ano

The surgical management of complex fistula-in-ano can be difficult, and often requires a seton suture or a colostomy. An alternative procedure is presented, based on principles that have been used successfully in the treatment of rectovaginal fistulas. The essential components of the technique are closure of the internal opening (when possible by an endorectal advancement flap), wide external drainage, and curettage of the fistulous tract. Seven patients with complex fistulas-in-ano were treated by this method. Six were cured and had excellent functional results up to 32 +/- 36 months postoperatively. The time to complete healing was 2.1 +/- 0.75 months. One patient developed a recurrent abscess. The procedure described is an alternative to conventional methods used in the treatment of complex fistula-in-ano.