Fistulectomy with Primary Sphincter Reconstruction
Even in the new millennium, high anal fistulas are still a challenge in colorectal surgery. In former years, the standard of care was complete fistulectomy with a high rate of continence disorders. Over the last 20–30 years, flap procedures have gained wide acceptance and were used in these cases. Also, many patients stayed with a long-term seton as definite treatment. The main problem of all surgical possibilities is a high recurrence rate with 30–50 % in flap procedures and 100 % of persistence in seton treatments. In recent years, we started to do a direct repair (primary reconstruction) in distal fistulas with excellent results and evolved our technique for proximal (high) anal fistulas.
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