Comparison of clinical outcomes between remodified Hanley procedure and modified Hanley procedure for high complex horseshoe fistula: a retrospective study

Treating high horseshoe anal fistula (HHAF) with the modified Halley procedure (MHP) often falls short when focusing solely on deep postanal space (DPAS) drainage. Our study underscores the significance of addressing deep posterior intersphincteric space (DPIS) drainage, prompting MHP modifications.

We studied consecutive patients with HHAF treated with either MHP or remodified-MHP (Re-MHP) at Ningbo Medical Center of Lihuili Hospital from January 2018 to December 2021. Postoperative outcomes, encompassing complications, cure rates, pain, anal incontinence, and quality of life, were retrospectively assessed.

Cure rates for MHP and Re-MHP were 95.3% (41/43) and 82.1% (32/39), respectively, without statistical significance (χ² = 3.7, P = 0.08). VAS-PS, CCF-IS, and QLAF-QS scores significantly increased postsurgery and gradually decreased. Notably, Re-MHP demonstrated significantly lower VAS-PS scores during the first postoperative week, lower QLAF-QS scores on the seventh day, and more drainage secretions on the first day (P < 0.05).

Simultaneously enhancing DPAS and DPIS drainage in Re-MHP can enhance the cure rates of HHAF patients while preserving minimally invasive attributes.