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TOTAL FISTULECTOMY, ANOPLASTY, SPHINCTEROPLASTY AND PARTIAL CLOSURE OF RESIDUAL CAVITY FOR TRANS-SPHINCTERIC PERIANAL FISTULA
Domenico Mascagni^*1, Pietro Mascagni¹, Edoardo Toscana¹, Domenico Di Nardo¹, Daniele Pironi¹, Alessandra Panarese¹, Chiara Eberspacher¹, Emanuele Felli^2
1 "Sapienza" University of Rome, Rome, Italy; ²Service de Chirurgie Générale, Hépatique et Transplantation, Hopital Hautepierre, Strasbourg, France

Background: Perianal fistula is a complex and common disease. Still today no technique has shown its absolute superiority in terms of efficacy and recurrence rate. The technique has to be chosen considering the balance between fecal continence preservation and disease eradication. The use of non-cutting techniques is widely increased in the last years, together with the number of the procedures performed on the same patient. Fistulecomy is still the gold standard in the intersphincteric and low trans-sphinteric fistulas but with a long healing time and with a considerable percentage of soiling and alterations of continence. Rarely simultaneous perianal abscess and fistula are treated at the same time, and often full recovery takes long time. The aim of this study is to evaluate the possibility of treating, in a single procedure, the fistula tract and the eventual abscess reducing the healing time with total fistulectomy, anoplasty, sphincteroplasty and partial closure of residual cavity, in order to minimize soiling and sphincter impairment.
Methods: A non-randomized single center series of 135 patient from 2007 to 2015 was treated for low-medium trans-sphincteric perianal fistula, with or without synchronous perianal abscess, performing total fistulectomy, anoplasty, sphincteroplasty and partial closure of the residual cavity technique.
Results: Success rate was 95%, with a healing time of 4 weeks; overall morbility was 16,2%; recurrence rate was 5%; no major alterations of continence were observed.
Conclusions: Fistulectomy, anoplasty, sphincteroplasty and partial closure of residual cavity are associated with a lower rate of recurrence and acceptable fecal continence preservation. This technique can be safely performed with reduction in the healing time and in the number of procedures required.

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