Retrospective Evaluation of Outcome of Rerouting Technique in Management of Horseshoe Perianal Fistula, Single Institution Experience

Abstract

Background: Complex anal fistula is a topic of debate from ancient times due to its difficult treatment and its effect on patients quality of life. The most complex anal fistula is the branched transsphincteric fistula with secondary extension in the perianal spaces forming the configuration U-shaped or horseshoe fistula. Many surgical technique have been described for treatment of this fistula as fistulotomy as was described by Hanly 1965 but he noted high risk of anal incontinence despite the complete eradication of the deep post anal sepsis. Aim of Study: To evaluate retrospectively patients with complex horseshoe fistula for them re-routing technique was done with respect to operative time, occurrence of incontinence and rate of recurrence of the fistula. Patients and Methods: This study is a retrospective ob-servational study that was conducted on 30 patients who had complex horseshoe perianal fistula and underwent re-routing technique for the fistula in the last 3 years; from January 2017 to December 2019. Follow-up of the patients was for 6 months. They were recruited from General Surgery Department, Ain Shams University Hospitals (El-Demerdash), Ain Shams University, Egypt. Results: Of the 30 patients, 27 patients (90%) preserved complete and full continence. Only 3 patients (10%) developed incontinence post-operatively after the second stage, stage of rerouting. Of the 3 patients developed incontinence, 2 patients (6.7%) developed only gas incontinence which is according to wexner scoring system was "sometimes" that occurred less than once per week and only 1 patient (3.3%) developed gas and liquid stool incontinence which according to the wexner score system was "rare" that occurred less than once per month. All 3 cases developed incontinence didn't need to wear pads and there was no effect on their life style. After 6 months follow-up of the patients, recurrence occurred only in 2 patients (6.7%) at 3.5 and 5 months which was not statistically significant. Conclusion: Rerouting technique is a suitable proper sphincter preserving procedure for the management of the complex horse shoe perianal fistula with low recurrence rate, very acceptable and satisfactory magnitude of preservation of anal continence with no effect on patient's quality of life.