High ligation of the fistula track by lateral approach: a modified sphincter-saving technique for advanced anal fistulas

Aim Ligation of the intersphincteric fistula track is a novel surgical procedure with the advantage of avoiding anal incontinence. We conducted a preliminary investigation of a modified technique for complicated trans-sphincteric anal fistula by high ligation of the track using a lateral approach. Method From June 2010 to May 2011, 10 patients received high ligation of the fistula track using a lateral approach. Patients selected for the procedure had a mature trans-sphincteric type of anal fistula that involved a significant amount of the external sphincter. Patients with early fistulous abscess or with a history of previous anal surgery were excluded. The surgical technique involved making an incision from the external opening and extending this towards the direction of the internal opening, dissection of the fistula from the underlying soft tissue, high ligation above the internal sphincter and removal of the distal part of the fistula track for pathological examination. Results Of the 10 patients, eight were men and the mean +/- SD age was 40.5 +/- 7.23 years. The median (range) duration of follow-up was 7 (610) months. In all patients, the wound was completely healed by the sixth postoperative week. Two cases of recurrence were noted later and were successfully managed by traditional fistulotomy. Conclusion High-ligation surgery of the fistula track for trans-sphincteric anal fistula, aimed at total anal sphincter preservation, has shown encouraging early results. Long-term follow-up and randomized controlled trials are necessary.