DOI: https://doi.org/10.36347/sasjs.2024.v10i12.008

Pages: 1402-1407

Background: Fistulectomy with primary closure of the internal opening has been used to treat high trans-sphincteric fistula in ano. This method entails complete removal of the fistula tract from external opening to internal opening and closing the internal opening from the inside of anal canal. This study aims to assess the outcomes of fistulectomy with closure of the internal opening for high trans sphincteric fistula. Methods: Observational study was carried out in the Department of Colorectal Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Total 36 patients with high trans sphincteric fistula were included in this study. After preoperative MRI of anorectum, fistulectomy with closure of the internal opening was done. Results: The mean age was found 39.4 years with range from 20 to 57 years. Among 36 patients, 83.3% patients had primary wound healing within 6 weeks and rest of the patients healed within 10 weeks. Clinical squeeze pressure was reduced in 11.1% patients. Thirty two patients were available for 1 year follow up. Recurrence occurred in 21.88% (n=32) patients within the study period. 91.7% patients had Park-Brown continence grade-A and 8.3% had grade-B. Wound infection did not impair postoperative continence (p>0.05). There was statistically significant difference between wound infection and suture line dehiscence with fistula recurrence (P<0.05). Conclusion: Since the recurrence and incontinence rate were low, clinical squeeze pressure did not significantly reduced along with quick healing rate, fistulectomy with closure of the internal opening is an effective treatment option for high trans-sphincteric fistula in ano.