Tract de-epithelialization with internal orifice closure: a sphincter-sparing fistula-in-ano repair: DOCS-FR

Cryptoglandular perianal fistula is a common condition that negatively affects patients' quality of life and can potentially lead to life-threatening perianal sepsis. In the specific case of. the inter- or trans-sphincteric variants, the risk of incontinence remains a concern. The aim of the present technical note is to describe a surgical technique aimed at: (1) De-epithelializing the fistula tract with a stainless-steel wire rope guided helical curettage; (2) Excising the fistula external orifice; (3) Suture closing the fistula internal orifice thereby isolating the de-epithelialized tract; (4) Leaving the sphincter alone. The main advantages of the present technique include potentially more definitive benefits compared with seton placement, applicability in patients not suitable for fistulotomy due to risk of incontinence, low cost, and ease of implementation in clinical settings.