Re-routing of the tract in the treatment of high anal fistula: A single-center experience

Background: High anal fistulae require more complicated treatment than low anal fistulae. Because of their complexity, this study aimed to assess the re-routing role in the high anal fistulae treatment, as well as to assess recurrence and incontinence, and determine whether re-routing of the tract is a good option for treating high anal fistulae. Methods: It is a prospective interventional study that was conducted on 83 patients with high perianal fistula, ranging in age from 18 to 72 years old, of both genders. All cases were assigned to history taking, laboratory investigations, clinical examination (general examination and local examination), and magnetic resonance imaging [MRI] for objective delineation of the fistulous tractand its attribution with the anal sphincters. Results: · After a minimum follow-up period of 9 months, 5 cases (6.02%) experienced recurrence. Mild incontinence was reported in 4 patients (4.8%), while 4 patients (4.8%) developed infection. Additionally, tractgangrene was observed in 2 patients (2.41%). · In multivariate regression, suprasphincteric fistulae, and infection were independent predictors for recurrence. Conclusion: The re-routing procedure is a feasible and safe surgical option for managing high transsphincteric perianal fistulae. It is associated with low postoperative complication rates, including short-term recurrence. It combines the advantages of fistulotomy and sphincter-preserving fistula surgery. However, further studies involving a large number of suprasphincteric fistula cases are needed to evaluate the efficacy of the re-routing technique in treating such fistulae.