Immediate reconstruction of the anal sphincter after fistulectomy in the management of complex anal fistulas

An analysis was made of the indications and outcome of immediate reconstruction of the anal sphincter after fistulectomy in the management of a selected group of patients who were at risk of post-operative incontinence. A total of 31 patients underwent surgery, with 25 high trans-sphincteric fistulas (80.6%), four low trans-sphincteric fistulas (12.9%), and two suprasphincteric fistulas (6.5%). The median post-operative stay was 7.0 days, with a median follow up of 24.0 months. We describe one case (3.2%) of post-operative infection and dehiscence of the muscle suture. The fistula recurred in three patients (9.7%). At the end of follow up of 25 patients with full preoperative continence, five patients (20.0%) presented with perianal soiling and one (4.0%) had incontinence to flatus. Sphincter reconstruction after fistulectomy constitutes a management option that should be considered in the treatment of certain fistulas. It allows both rapid recovery and the preservation of anal function.