Using Minimally Invasive Sphincter-Sparing Techniques of Surgical Treatment of Transsphincteric Anal Fistulas: A Focus on Preserving Anal Sphincter Function

Background: The existing recommendations for the diagnosis and treatment of anal cryptoglandular transsphincteric fistulas (AF) are contradictory, which makes practical decisions in its treatment extremely difficult. Methods: 82 patients were examined after surgery for AF. All the patients were divided into three groups: the first included patients who underwent fistulotomy (n = 17) and fistulectomy (n = 9); the second, who underwent ligation of the intersphincteric fistula (LIFT, n = 29); and the third, treated with bio-welding of the AF (n = 27). Results: Positive short-term results were obtained in all groups, in 53.8%, 82.8%, and 85.2% of cases, respectively. The effect of biowelding of AF was achieved due to electrothermal denaturation and the appearance of common space between protein molecules with a small area of heat propagation, less than 1-2 mm. The immunohistochemical studies showed that cells had produced neutrophilic granulocytes and proinflammatory interleukins in both the intra-and extrasphincteric parts of AF.