Surgery in an Intersphincteric Fistula

ABSTRACT

An intersphincteric fistula is the most common type of fistula, about 70% of all fistulas, and is often encountered by the surgeon during anal surgery. The operative procedures include a simple fistulotomy, a fistulectomy, a cutting seton technique, and a sphincter-saving technique. Most posterior-located intersphincteric fistulas can be successfully treated by using the lay-open technique, but using that technique in cases of lateral- or anterior-located fistulas may result in incontinence or anal deformity. In this respect, a sphincter-saving technique has more advantage in sparing anal function than other procedures in cases of lateral or anterior fistulas, but the recurrence rate is high. The delayed open method with seton techniques have a low recurrence rate, but do not preserve anal function well. As mentioned above, the operative method for treating intersphincteric fistulas should be suitable for keeping sphincter tone and should have a low recurrence rate. This article discusses the rationale for and the estimated effectiveness of many operative methods for treating intersphincteric fistulas.