Ligation of intersphincteric fistula tract for complex anorectal fistulas with initial promising results

Background: The aim of anal fistula treatment is to cure the disease without any risk for fecal incontinence. Surgery for treating anal fistulas can be divided into two types: sphincter-sacrificing and sphincter-saving methods. There are many sphinctersaving operations such as ligation of the intersphincteric fistula tract, application of fibrin glue, endorectal advancement flap, and video-assisted fistula surgery. Objective: The aim of this study was to evaluate the effectiveness of intersphincteric ligation of the fistulous tract in the management of complex anal fistula. Design: Study of patients with complex anal fistulas was done prospectively from 1 September 2013 to 31 January 2015. Patients’ data, fistula type determined by magnetic resonance imaging, continence scales before and after surgery, previous surgery, healing rates, recurrence rates, re-do in recurrent cases, and complications were recorded. Settings: The study was conducted at a single tertiary care institution. Patients: Eighteen patients were included. Main outcome measures: These included recurrences, surgical time, complications, and fecal incontinence. Results: The study included 18 patients. Two patients were female and 16 were male. The mean age was 35.55±9.89. The median wound-healing time was 2.44 weeks. Of the 18 patients, 16 (88.9%) had complete healing of the fistula. None of the patients developed fecal incontinence. Conclusion: Ligation of the intersphincteric fistulous tract is an effective technique for treatment of anal fistula. It is also a good option for maintaining continence and sphincter saving in the management of fistula-in-ano. Study limitations: The small number of patients and the short follow-up period are the major limitations of this study.