Work

Surgical Treatment of Complex Perianal Fistula Through Fistulectomy, With Total Extraction of the Fistulous Tract

Year: 2024

Type: article

Abstract: Case Presentation A male patient diagnosed with a complex transsphincteric perianal fistula. The decision was made to perform a first-stage surgical correction using the fistulectomy technique, with complete removal of the fistulous tract, ensuring the preservation of the sphincter muscle and isolating it with a Seton to allow drainage of the fistulous tract. The subcutaneous tissue in the resected area was approximated to shorten the healing time. A second intervention was performed three months after the first to allow for the proliferation of the fibrotic healing process, enabling the safe division of the muscle isolated by the Seton without the risk of incontinence, followed by curettage of the surgical wound for healing by secondary intention. The patient showed good postoperative progress with no complications. Discussion Complex perianal fistulas with extensive involvement of the external sphincter muscle are a therapeutic challenge due to the increased risks of fecal incontinence and recurrence. The therapeutic strategy should aim for high success rates while maintaining continence. In fistulotomy, the fistulous tract is kept open, whereas in fistulectomy, the entire tract is completely resected to reduce the risk of recurrence from the loss of secondary tracts, in addition to providing a complete histological sample for study. Conclusion Fistulectomy is a good surgical option for complex perianal fistulas. To avoid complications, dissections should be performed near the fistulous tract, isolating and preserving the sphincter muscle, and completing the procedure in a second stage. This technique demonstrates good results in curing the disease, with low rates of postoperative complications and morbidity. Several techniques are available for complex perianal fistulas, all with the possibility of recurrence and complications, making the surgical treatment of these fistulas a challenge for surgeons. Publication History Article published online: 25 April 2025 © 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/) Thieme Revinter Publicações Ltda. Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

Source: Journal of Coloproctology

DOI: 10.1055/s-0045-1808932