The fistulectome: a new device for treatment of complex anal fistulas by "Core-Out" fistulectomy.

PURPOSE: In an attempt to improve the quality of life of patients with high anal fistula, we developed a new mechanical device, a "fistulectome," which excises the fistula tract in a totally controlled manner, particularly useful in the treatment of high anal fistulas. The "fistulectomy set" consists of a flexible shaft, cannulation and fixation guides, an incisor mouth, and a handle, which is simultaneously used for motor housing. METHODS: The principle of the treatment is to excise approximately 2-mm thickness of the fistula tract circumferentially, which in fact is a "coring-out" procedure. The fistula tract is likewise transformed into a cylindrical cavity encircled by healthy tissue. This is achieved by the fistulectomy set, consisting of a flexible shaft, cannulation and fixation guides, an incisor mouth, and a handle simultaneously used for motor housing. RESULTS: Between March 2001 and April 2002, a total of 13 consecutive patients with anal fistula underwent excision of fistula tracts. All patients except one had previously been operated on for anal fistula. The distribution of fistulas was as follows: transsphincteric, six patients; suprasphincteric, three patients; extrasphincteric, three patients; multiple, one patient. Mean follow-up was 13.4 (range 7.5-18) months. Gas incontinence in one patient, soiling in one patient, and recurrence in one patient was observed. No recurrences, stool, or gas incontinence were observed in ten patients. CONCLUSIONS: Excision of fistula tract performed by the recently developed fistulectome is a minimally invasive, safe, and effective method to be considered in the treatment of anal fistula. The results obtained up to date were encouraging, although the patient number was limited.