Core out fistulectomy, anal sphincter reconstruction and primary repair of internal opening in the treatment of complex anal fistula.

OBJECTIVE: To determine the surgical technique "core out fistulectomy with anal sphincter reconstruction and primary closure of internal opening" in the treatment of trans-sphincteric fistula (high type or long tract) or supra-sphincteric fistula in terms of fistula healing, morbidity, recurrence and anal continence. MATERIAL AND METHOD: Between January 2004 and December 2005, 33 patients were enrolled in the present study. There were 30 males and 3 females with median age 42 (range 19-73) years. Most patients were high trans-sphincteric type (94%). The patients who had intersphincteric fistula, short tract trans-sphincteric fistula, fecal incontinence, or anal sphincter impairment were excluded. RESULTS: The median operative time was 35 (range 20-90) minutes. Median follow up was 14 (range 6-20) months. The median healing time was 4 weeks (range: 2 to 5 weeks) with minimal disturbance over patient life. There was one postoperative perianal hematoma treated by nonoperative mean and four cases of recurrent fistulas (cured by second operation) with no continence disturbance noted during the follow-up period. CONCLUSION: Core out fistulectomy with anal sphincter reconstruction and primary closure of internal opening is an effective procedure to be considered in the treatment of trans-sphincteric fistula (high type or long tract) with a satisfactory result while preserving both internal and external sphincters.