Fistulotomy and primary sphincter reconstruction is a useful tool in the management of anoperineal fistula: Results of a two-center retrospective study - 20/08/26

Doi : 10.1016/j.jviscsurg.2026.07.008

Aniss Nasraoui ^a, Vincent de Parades ^a, Mounzer Dia ^b,^c, Maëlig Poitevin ^b,^c, Aurélien Venara ^c,^d,⁎

^a Groupe hospitalier Saint-Joseph, service de proctologie médicochirurgicale, 185, rue Raymond-Losserand, 75014 Paris, France

^b Faculté de santé, département de médecine, université d’Angers, Angers, France

^c Service de chirurgie viscérale et endocrinienne, CHU d’Angers, 4, rue Larrey, 49933 Angers, France

^d Nantes Université, CHU de Nantes, Inserm, The Enteric Nervous System in Gut and Brain Disorders, IMAD, Nantes, France

^⁎ Corresponding author at: Department of Visceral Surgery, CHU d’Angers (Angers University Hospital), 4, rue Larrey, 49933 Angers cedex 09, France. Department of Visceral Surgery, CHU d’Angers (Angers University Hospital) 4, rue Larrey Angers cedex 09 49933 France

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 20 August 2026

Highlights

•	Treating anoperineal fistulas leads to a risk of anal incontinence of approximately 14%.
•	Compared to conventional sphincter-sparing techniques, fistulotomy plus sphincter reconstruction may reduce the risk of recurrence.
•	Fistulotomy plus sphincter reconstruction does not increase operative morbidity compared to conventional sphincter-sparing techniques.
•	Fistulotomy plus sphincter reconstruction does not increase the healing rate compared to conventional sphincteric sparing techniques.

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Summary

Introduction

Anoperineal fistula (APF) treated by fistulectomy provides the best anatomical results but carries a high risk of anal incontinence. Sphincter reconstruction might improve these outcomes, but limited comparative data are available in the literature. The purpose of this study was to compare the outcomes of fistulotomy plus sphincter reconstruction (FSR) and sphincter-sparing techniques for APF repair.

Method

This two-center retrospective study included patients undergoing FSR or ligation of the intersphincteric fistula tract (LIFT) or rectal advancement flap (control group) techniques.

Results

Of the 119 patients included, 95 (79.8%) underwent FSR. There were no statistically significant differences in demographic characteristics between groups. More inter- or trans-sphincteric fistulas were included in the control group, while there were more complex fistulas in the FSR group ( P < 0.001). The healing rate was 76.2% in the control group compared to 91.6% in the FSR group ( P = 0.056). No statistically significant difference was found in the overall complication (8.4%) or overall anal incontinence rates (14.7%) ( P > 0.9). In contrast, the recurrence rate was higher in the control group than in the FSR group ( P < 0.001). In multivariable analysis, FSR was associated with a lower risk of recurrence compared to the control group (OR = 0.16; 95% CI: 0.03–0.77).