TREATMENT OF RECURRENT HIGH ANAL FISTULA BY TOTAL EXCISION AND PRIMARY SPHINCTER RECONSTRUCTION

Fourteen patients with recurrent high anal fistula were treated by tot al excision of the fistulous tract with primary sphincter reconstructi on. Nine patients with sepsis had seton drainage for one to three mont hs before the operation. The surgical approach was the transsphincteri c technique described by Mason. No covering stoma was used routinely, but three patients referred with a colostomy had the stoma closed 3 to 5 months later. After a follow-up from 1 to 4 years two patients had recurrence, which in one necessitated a diverting ileostomy. Three pat ients, one with recurrence and two without, suffered from minor anal i ncontinence. It is concluded that total excision with primary sphincte r reconstruction is a treatment modality which should be considered fo r recurrent high anal fistula, especially in patients where closure by an advancement flap is not possible.