[Sphincter-preserving surgery of trans-sphincteric anal fistulas]

The "laying open" technique is the standard method of treating fistulas-in-ano. Laying open transsphincteric (high anal) fistulas involves division of a part of the external anal sphincter and may result in incontinence. In 12 patients with high transsphincteric fistula (7 with previous surgery to attempt fistula healing) we have used a sphincter-saving surgical method: excision of the fistula tract and closure of the internal opening by suture of the internal anal sphincter. Fistulas were eradicated in 8 patients (67%) without incontinence. In 4 patients the fistulas persisted. It is concluded that transanal closure of the internal opening and perianal fistula excision can be an effective method of treating transsphincteric fistulas without sphincterotomy, thus avoiding the risk of incontinence.