eP551 - A Novel Technique to Treat High Transphincteric Anal Fistula

Purpose/Background: Anal fistula is a commonly encountered anorectal condition distinguished by chronic infectious symptoms, which can significantly diminish the patients' quality of life. The sphincter-sparing approach appears to be an ideal surgical intervention for the treatment of anal fistulas, as it offers a combination of a high success rate and the preservation of normal anal function. However, it still remains room to improve the treat efficacy. We introduce an enhanced sphincter-saving approach for treating high transphincteric anal fistulas, developed by our expert team.Methods/Interventions: This study evaluated a cohort of patients with high transphincteric anal fistulas who underwent a novel surgical procedure (Figure 1) at a specialized referral institute from October 2021 to December 2022 (n=30). Data, encompassing success rates, anal function, and various surgical characteristics were systematically collected and subsequently subjected to rigorous analysis.Results/Outcomes: In this study, a cohort of thirty patients, consisting of 25 males (median age [IQR]:34.5[31-40]) was included in this study. Of this group, 20 patients completed the assessments of Wexner scores and Quality of Life in patients with Anal Fistula Questionnaire. All patients underwent the novel procedure, with a median operation time of 62 [range 48-70] minutes. The median volume of blood loss during the surgical intervention was 5 ml. No unexpected adverse events occurred during the surgical procedure. Over a follow-up period of at least eleven months (with a median time of 17 months and a range from 11 to 30 months), it was observed that 90% of the patients (n=27) achieved healing. A small subset of patients, accounting for 6.7% (n=2), experienced recurrence at the six-month and two-year post-operation, while a mere 3.3% of patients (n=1) encountered treatment failure. Importantly, the patients exhibited a maintenance of satisfactory anal continence, with no statistically significant difference observed between preoperative and postoperative Wexner scores (P=0.425). In comparison to the preoperative assessment, a significant improvement in the quality of life was observed (P < 0.001).Conclusion/

Discussion: The primary results of the novel technique presents an effective approach to high complex transphincteric anal fistula with high heal rate and satisfied anal function. We recommend conducting larger prospective studies with longer-term follow-up to further validate these findings.A posterior high transphincteric anal fistula was treated with the novel surgical intervention.