Fistulectomy and Primary Sphincteroplasty for Transsphincteric Fistula

Area of Science:

• Colorectal Surgery
• Gastroenterology
• Surgical Innovation

Background:

• Perianal fistulas are complex anorectal conditions often associated with perianal abscesses.
• Surgical management aims to eradicate the fistula tract while preserving anal continence.
• Fistulectomy combined with primary sphincteroplasty is a technique explored for treating these conditions.

Purpose of the Study:

• To evaluate the efficacy of fistulectomy and primary sphincteroplasty for uncomplicated perianal fistulas.
• To assess the impact of this surgical approach on anal continence and quality of life.

Main Methods:

• An observational study involving 44 patients undergoing fistulectomy with primary sphincteroplasty between 2020 and 2023.
• Retrospective analysis of clinical data, including preoperative perianal MRI and Cleveland Clinic Incontinence Score (CCIS).
• Postoperative follow-up at specific intervals to assess outcomes and recurrence.

Main Results:

• A low recurrence rate of 2.3% (1 patient) was observed.
• No statistically significant difference in CCIS was found between preoperative and 3-month postoperative scores (mean 1.6 vs. 1.7, p >0.05).
• Only 3 patients (6.8%) experienced minor worsening of incontinence.

Conclusions:

• Fistulectomy with primary sphincteroplasty is an effective and reliable surgical method for perianal fistulas.
• The procedure demonstrates success in preserving anal continence.
• This surgical technique contributes to an improved quality of life for patients.