Preliminary results of a novel sphincter-sparing technique-fistula occlusion with the internal sphincter flap (FOISF)-for high complex anal fistulas.

BACKGROUND AND AIM

High complex anal fistula is a clinical challenge for proctologists and a nightmare for patients. Although the sphincter-sparing approach seems an ideal surgical intervention, there remains room for improvement in treatment efficacy. Herein, we introduce an enhanced sphincter-sparing approach, namely the fistula occlusion with the internal sphincter flap (FOISF), for treating high complex anal fistulas.

METHODS

This study evaluated 15 patients with high complex anal fistulas who underwent FOISF between October 2021 and December 2022 in the Sixth Affiliated Hospital, Sun Yat-sen University (Guangzhou, P. R. China). Data on success rates, anal function, and various surgical characteristics were subjected to rigorous analysis.

RESULTS

All patients underwent the FOISF procedure, with a median operation time of 53 min. Fourteen patients achieved primary intention healing, while one patient healed by second intention. No recurrence was observed over a follow-up period of 14-30 months. All patients exhibited satisfactory anal continence, with no statistically significant difference observed between preoperative and postoperative Wexner scores (=0.331). A significant improvement in the quality of life was observed when compared with the preoperative assessment (<0.001).

CONCLUSION

The preliminary results of the FOISF procedure present an effective approach to treat high complex anal fistula.