Jeddah Experience in the Management of High Anal Fistula

Abstract

Twenty-six (26) transsphincteric anal fistulae with secondary high extensions and sixteen (16) suprasphincteric anal fistulae with secondary high extensions have been treated successfully over a period of 3 years. The operative technique depends on exploration of the intersphincteric plane with removal of the primary source of the infection, together with excision of the primary tract, and drainage of the secondary high extensions. The patients have been followed for 2 years without recurrence. Continence for flatus and liquid feces was 92.1% and 96.15%, respectively, in the transsphincteric and 75% and 93.75%, respectively, in the suprasphincteric group but the continence for solid feces was 100% in both. Thus, the so-called excision technique for treatment of high fistula is safe and results are excellent. To lay open a fistula without exact identification of the primary tract and its relation to the sphincteric muscles, is a dangerous procedure [4], as the laying open of transsphincteric running tract can lead to impaired continence particularly in elderly people who have weaker sphincters [5]. High fistula-in-ano is a real problem of considerable surgical importance. We have a large number of recurrent cases with persistent pain, recurrent abscesses, and distress related to being unclean for prayer referred to us. This paper describes our operative technique and reports our results. 1986 and 1989, 42 patients with high fistula-in-ano were treated at King Fahd Hospital and Al Shaty Hospital in Jeddah. The median age was 42 years (range 26 to 56). Twenty-six (23 males and 3 females) had transsphincteric and 16 (14 males and 2 females) suprasphincteric fistulae, both associated with high secondary extensions penetrating the levator plate. All 42 patients had undergone previous surgery an average of 6 times for the transsphincteric group and 8 times for the suprasphincteric group. Material and Methods Between