Management of high recurrent anal fistula

Fifteen patients who had recurrent high anal fistulas were treated at the Mount Sinai Medical Center from 1975 to 1981--12 men and 3 women, all of whom had already undergone fistulectomies from one to four times elsewhere. The fistulas were managed with coring of the tract (complete extirpation), including side tracts, if present, and primary closure of the internal opening with advancement rectal mucosal flap distal to the original fistulous opening. Thirteen of 15 patients had satisfactory results; two patients required reoperation for recurrences. The advantages of the advancement flap technique over the staging division technique are discussed. We have found our procedure to be very useful for high anal fistulas, particularly for patients with recurrent high anal fistulas in whom there is already some degree of sphincter damage and scar formation.