Journal Information
Vol. 39. Issue S1.
Pages 197 (November 2019)
Download PDF
More article options
Vol. 39. Issue S1.
Pages 197 (November 2019)
Open Access
Fistulotomy and primary end to end sphincteroplasty for cryptogenic anal fistula (F.I.P.S.). results and lessons learned
U. Morelli
Clínica de Proctologia Dr. Umberto Morelli, São Paulo, SP, Brasil
Article information
Full Text

Área: Doenças Anorretais Benignas

Categoria: Estudo clínico não randomizado

Forma de Apresentação: Tema Livre (apresentação oral)

Objective: Recently, sphincter reconstruction after fistulectomy or fistulotomy was technically recognized as a stand‐alone technique. Before, was technically forbidden, alleging various motivations (high wound dehiscence rates, high recurrence rate etc). We present here the results obtained in a 5 year retrospective study where fistulotomy and primary end‐to‐end sphincteroplasty with a modified technique were used to treat cryptogenic anal fistulas.

Method: This is a retrospective study. All patients were operated by a single surgeon (UM), with the same technique, fistulotomy associated to a fine excision of fistula tract tissue and primary end to end sphincteroplasty (of IAS, EAS or both), and a small anal mucosal flap to close the internal fistulous opening. All patients had a diagnosis of intersphincteric, trans‐sphincteric or suprasphincteric perianal fistulas (low, high and suprasphincteric fistulas were included in this study);all patients were submitted to a preoperative Pelvic MRI, anorectal manometry and colonoscopy. The Wexner Incontinence Score was calculated preoperatively and postoperatively for all patient. All were followed up as outpatients at 7 days,1 month, 3 and 6 months after surgery.

Results: 57 patients were studied, 42 males and 15 females, mean age 40,91 (19‐68). 20 patients were diagnosed with intersphincteric fistulas, 36 with transphincteric, 1 supra‐sphincteric (27 anterior and 30 posterior fistulas), with 26 complex fistulas and 31 single tract fistulas, 5 patients who presented recurrence and were previously operated by other surgeons. 2 patients related preoperative mild incontinence (resolved after surgery). Postoperative complications included 10 patients with delayed cicatrisation,1 postoperative (PO4) bleeding, 2 perianal dermatitis, 2 partial mucosal dehiscence with 1 patient needing mucosal resuturing,1 anal profile deformity (resulting in a mild temporary fecal incontinence). 2 patients (3,4%) had a total dehiscence needing re‐operative management. No recurrences were observed during follow up.

Conclusion: Fistulotomy and primary end‐to‐end sphincteroplasty is a safe surgical strategy to treat anal fistulas with low complication rate.

Journal of Coloproctology

Subscribe to our newsletter

Article options