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.

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

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).

This study suggests that FSR may be superior to the other techniques in terms of cure without increasing morbidity or the risk of anal incontinence.