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Session: ePoster: Benign Anorectal 3 (Sun225)

EP488 - Selective Internal–sphincter Staging–seton Fistulectomy: A Novel Technique for Sphincter Preservation in High Transsphincteric Anal Fistula Management

Sunday, May 11, 2025
2:52 PM – 2:57 PM PT
Location: Monitor 3, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • Yingying Li

    student
    Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine
    ShangHai, Shanghai, China (People's Republic)

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • Qianqian Ye

    Doctor
    Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine
    ShangHai, Shanghai, China (People's Republic)

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • CM

    Chang Mao, n/a

    student
    Shuguang Hospital affiliated with Shanghai University of Traditional Chinese Medicine
    Shanghai, Shanghai, China (People's Republic)

    Disclosure information not submitted.

  • BC

    Bo Chen, n/a

    student
    Shuguang Hospital affiliated with Shanghai University of Traditional Chinese Medicine
    Shanghai, Shanghai, China (People's Republic)

    Disclosure information not submitted.

  • ZM

    Zubing Mei, n/a

    Associate Chief Physician of Surgery
    Shuguang Hospital, Shanghai University of Traditional Chinese Medicine
    Shanghai, Shanghai, China (People's Republic)

    Disclosure information not submitted.

    • Senior Author(s)

  • QW

    Qingming Wang, Doctor

    professor
    Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine
    ShangHai, Shanghai, China (People's Republic)

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Yingying Li: This individual has no financial relationships with ineligible companies.
Qianqian Ye: This individual has no financial relationships with ineligible companies.
Qingming Wang, Doctor: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: The study introduces a novel surgical technique, Selective Internal–sphincter Staging–seton Fistulectomy (SISF), in a prospective single-arm cohort trial to assess its clinical efficacy, safety, and effectiveness in treating high transsphincteric anal fistula. The aim is to establish a scientific basis for the procedure and facilitate its clinical adoption as an advantageous surgical option.

Methods/Interventions: A prospective cohort study was initiated at Shuguang Hospital, affiliated with Shanghai University of Traditional Chinese Medicine. Eligible inpatients were identified and enrolled between April and June 2024. All participants underwent a meticulously planned SISF. The main outcome was the 2-month cure rate, while secondary outcomes encompassed short-term clinical outcomes, including the Visual Analog Scale for pain (VAS-PS), Cleveland Clinic Florida Incontinence Score (CCF-IS), perioperative metrics, and postoperative complications. Follow-up assessments were conducted at predefined intervals up to 2-month postoperatively. Data were analyzed using SPSS Statistics 25.0.

Results/Outcomes: The study cohort comprised 20 patients with high transsphincteric anal fistulae, predominantly males (90%), with a mean age of 38.45 years (SD 8.23; range 27-59). Preoperative assessments revealed a mean VAS-PS of 4.45 (SD 1.39, range 0-10), a mean CCF-IS score of 0.25 (SD 0.55, range 0-20), and a mean CAF-QoL scale-Domin A score of 6.55 (SD 2.06 , range 0-20). The mean operative duration was 25.85 minutes (SD 4.84; range 20.00-36.00), with a mean intraoperative blood loss of 10.95ml (SD 5.01). At the 4-week outpatient follow-up, 9(45%) demonstrated complete healing, with 11 (55%) showing closure of the internal opening. The 2-month follow-up revealed a mean VAS-PS of 0.45(SD 0.69, range 0-10) and a mean CCF-IS of 0.10 (SD 0.30, range 0-20). The 2-month cure rate was 95%. Complications included one case of urinary retention (5%) and one case of postoperative bleeding (5%), with no instances of anal incontinence.

Conclusion/Discussion: The SISF procedure emerges as an efficacious treatment for high transsphincteric anal fistula, characterized by a low recurrence rate and a straightforward application principle conducive to clinical dissemination. It offers sphincter muscle preservation, alleviates postoperative discomfort, and is proposed as a secure and efficacious surgical modality for sphincter conservation.