BackgroundThe internal orifice plays an important role in the pathogenesis and treatment of the most complex fistula-in-ano. The treatment of the internal orifice is considered to be the key to the success of anal fistula surgery. The objective of this study is to evaluate the feasibility of a new sphincter-sparing surgical approach for anal fistula.Materials and MethodsAll hospitalized anal fistula patients were included in this study. Preoperative anorectal ultrasound was done on all the patients. Transanal internal orifice alloy closure (IOAC) was performed through a disposable titanium nickel alloy anal fistula stapler. The external sphincter was not cut. An anal fistula brush was used to curette and clean fistulas. Postoperative anorectal color ultrasound was used for evaluation 2 months postoperatively.ResultsTwenty-one patients (male/female: 18/3, age: 39.7 ± 10.5 years) with fistula-in-ano were included (follow-up: 6–11 months).In total, 38.1% (8) had multiple tracts, and 9.5% (2) belonged to a high anal fistula. In total, 23.8% (5) of anal fistula patients were complicated by Crohn’s disease. The fistula healed completely in 85.7% (18/21) and did not heal in 14.3% (3/21). Three patients who did not heal had conventional surgery reperformed and eventually healed. Except for three patients undergoing additional traditional anal fistula surgery, the Wexner incontinence scores of other patients did not change after surgery compared with before surgery.ConclusionsIOAC is a novel sphincter-saving technique that is simply effective in treating anal fistula containing Crohn’s anal fistula.

We present five cases of perianal Paget disease (PPD). Two cases underwent a wide local excision (WLE) of PPD plus skin flap transfer surgery with good curative effect. One case of PPD complicated with mucinous adenocarcinoma underwent a laparoscopic abdominoperineal resection (Miles), which may be the extremes of clinical treatment of the disease. The remaining two cases passed away without surgery after they refused further treatments. This article aims to draw attention to relationship among the correct diagnosis, protection of anal function and treatment options of PPD.