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Cutting of the Intersphincteric Space for High Anal Fistula: Functional Preservation and a Predictive Model for
Jiawei Qin1, Yanyan Tan, Xueping Zheng
1Department of Colorectal Surgery, Nanjing Hospital of Chinese Medicine affiliated to Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
Journal of the American College of Surgeons
|March 2, 2026
Summary
The Cutting of the Intersphincteric Space (COIS) procedure offers effective treatment for high anal fistulas, balancing cure rates with sphincter preservation. A predictive model using gender, age, and neutrophil ratio aids in assessing functional decline risk post-surgery.
Area of Science:
- Colorectal Surgery
- Surgical Innovation
- Patient Outcomes
Background:
- High anal fistula (HAF) management is challenging due to high recurrence and incontinence risks.
- Sphincter-preserving techniques are crucial for maintaining anal function post-treatment.
- Assessing effectiveness and predicting functional decline are key for HAF treatment optimization.
Purpose of the Study:
- To evaluate the effectiveness of the Cutting of the Intersphincteric Space (COIS) procedure for HAF.
- To develop a predictive model for postoperative functional decline after COIS.
- To identify predictors of anal functional status changes post-COIS.
Main Methods:
- Prospective single-center cohort study of 146 HAF patients undergoing COIS.
- 18-month follow-up assessing anal functional status via Wexner incontinence score.
- Multivariate logistic regression identified predictors of functional decline; a nomogram was developed.
Main Results:
- COIS demonstrated a low recurrence rate (4.8%) and acceptable functional outcomes.
- 11.6% of patients experienced significant anal functional decline.
- Gender, age, and neutrophil ratio (NR) were independent predictors of functional decline (AUC = 0.739).
Conclusions:
- COIS is a functionally optimized approach for HAF, preserving sphincter integrity while achieving radical cure.
- A predictive model integrating gender, age, and NR enhances personalized risk assessment for functional decline.
- This approach shifts HAF management towards function-preserving strategies, emphasizing metabolic and inflammatory profiling.
