EP487 - Multi-Incision And Tube-Dragging Therapy Combined With Laser Closure (MITD-LaC): A Novel Approach In The Management Of High Horseshoe-Shaped Anal Fistula

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Purpose/Background: Surgical intervention for high horseshoe-shaped anal fistula (HHAF) frequently incurs damage to the anal sphincter, predisposing patients to severe complications. Given this challenge, the exploration of novel sphincter-sparing surgical techniques has become a paramount priority. The primary objective of this study is to evaluate the efficacy and safety of multi-incision and tube-dragging therapy combined with laser closure (MITD-LaC) in the management of HHAF. We aim to contribute valuable insights to the clinical landscape, aiming to mitigate the risks associated with traditional surgical methods and enhance patient outcomes.

Methods/Interventions: This study enrolled a total of 64 patients diagnosed with HHAF at a tertiary A-level hospital in Shanghai, China, between 2021 and 2024. The study design employed a randomized, single-blind trial, allocating patients randomly into an experimental group and a control group. The experimental group received treatment with MITD-LaC, while the control group underwent the conventional incision and thread-drawing therapy (ITD). The primary outcome was set as the wound healing time, and the secondary outcomes encompassed a range of crucial indicators within the first three postoperative months, including pain score assessed using the Visual Analogue Scale (VAS), anal function score such as the Cleveland Clinic Florida Incontinence Score (CCF-IS) and the incidence of complications (including infection, bleeding, and urinary retention), as well as the recurrence rates within the first six postoperative months.

Results/Outcomes: There were no statistically significant differences observed between the two groups in terms of sociodemographic characteristics (including age, gender, and BMI) or disease-related variables (such as disease duration, fistula classification, and history of prior perianal surgery). Notably, the mean wound healing time in the experimental group was significantly shorter, averaging (55.75 ± 4.07) days, compared to (59.57 ± 4.38) days in the control group (p=0.001). During the first two postoperative weeks, the VAS pain scores in the experimental group were significantly lower than those in the control group (p=0.004); however, this disparity was not sustained beyond this timeframe. Furthermore, on the 90th postoperative day, the CCF-IS of the experimental group exhibited a statistically significant decrease compared to that of the control group (p < 0.001). Within the three-month postoperative period, the incidence of complications in the experimental group was 6.25%, which was lower than the 15.6% observed in the control group (p=0.428). According to the six-month follow-up data, no recurrences were reported in the experimental group, while one recurrence occurred in the control group; however, the difference in recurrence rates between the two groups did not reach statistical significance (p> 0.05).

Conclusion/Discussion: The MITD-LaC not only effectively safeguards the function of the anal sphincter but also markedly expedites wound healing and mitigates postoperative complications along with the risk of recurrence. This discovery represents a novel perspective and approach in the clinical management of HHAF, underscoring its immense potential for practical clinical application. Future study endeavors ought to expand the sample size and embark on multi-centric randomized controlled trials to more comprehensively substantiate the efficacy and safety of this surgical method.