Fistulektomie mit primärer Sphinkterrekonstruktion bei transsphinktären Analfisteln

In the treatment of transsphincteric anal fistulas using fistulectomy and primary sphincter reconstruction, the current literature shows considerable variation in the available data on efficacy and morbidity. The aim of the study is to systematically record the results, complications and patient satisfaction at a large specialized center.

All patients who underwent transsphincteric anal fistula surgery using fistulectomy and direct sphincter reconstruction at the Neuperlach Clinic in Munich between 2017 and 2022 were included in the study. Patients with Crohn’s disease were excluded. In addition to the immediate hospital data, a follow-up was conducted that included both telephone and written surveys for long-term follow-up.

A total of 601 patients underwent anal fistula surgery during the observation period, 185 of whom met the inclusion criteria. After a follow-up of at least 1 year (median: 4.1 years), 143 patients could still be interviewed; at this time 79.0% of the patients showed good to perfect continence, 14.7% had moderate incontinence and 6.3% had severe incontinence. In 8.1% of all cases, complete dehiscence occurred postoperatively. The majority of the patients (88.8%) showed no recurrence of fistulas. Of the patients 94.4% were satisfied to very satisfied with the outcome. Overall healing could be recorded in approximately 90.0% of all patients. With inclusion of revision, it tends toward 100%.

The procedure shows a very low recurrence rate with comparable incontinence problems. The high cure rate and patient satisfaction, despite the possible complications, also speaks for the success of this method; however, an experienced surgeon is of crucial importance.