External Sphincter-Sparing Anal Fistulotomy Plus Seton Drainage for Complex Fistula-In-Ano

Aim: Several sphincter-saving surgical techniques have been developed, but overall healing rates have been mediocre.An external sphincter-sparing anal fistulotomy plus seton drainage (ESSAF-S) prioritizes the management of the intersphincteric space and involves dividing the internal sphincter and debriding the intersphincteric space to remove the focus of fistula formation.Method: This was a retrospective review of all patients who underwent ESSAF-S between January 2020 and December 2021 in a single institution.The primary outcome was the primary healing rate.Secondary outcomes included overall healing rate, postoperative complications, and incontinence rate based on the postoperative Wexner incontinence score (WIS).Results: A total of 21 patients (11 men, 10 women, mean age 43.1±12.3years) underwent ESSAF-S during the study period.The mean follow-up time was 11.9±4.4months.The primary healing rate was 76.2%.Five patients required a second procedure (3 fistulotomy, 2 fistula-tract laser closure), and 1 patient had a persistent fistula afterward.The overall healing rate was 95.2%.Two (9.5%) patients developed gas incontinence after the procedure.The median WIS was 0 (range: 0-13).There was no significant difference between the preoperative and postoperative WIS (p>0.05). Conclusion:An external sphincter-sparing anal fistulotomy plus seton drainage is an effective procedure for complex anal fistula with a high overall healing rate and low complication rate.