Coring Out Fistulectomy With Closure of Internal Sphincter Opening Versus Lay Open Fistulotomy and Primary Sphincter Repair in Transsphincteric Perianal Fistula

Fistula-in-ano is a common medical problem affecting thousands of patients annually. Symptoms generally affect quality of life significantly, and they range from minor discomfort and drainage with resultant hygienic problems to sepsis. Different classifications have been put forward which categorize these Fistula into low or high simple or complex, or according to their anatomy inter-sphincteric, trans-sphincteric, and supra- sphincteric or extra-sphincteric.

Conventional laying-open technique in high perianal fistula may involve sacrifice of part or whole of the sphincter muscle impairing continence. A transposition technique for the management of high anal and anorectal fistulae is described by Mann and Clifton in 1985. The method involves re-routing the extrasphincteric portion of the track into an intersphincteric position with immediate repair of the external sphincter.

Coring-out fistulectomy is a type of sphincter-preserving procedure that enables accurate resection of the fistula tract alone and thus reduces the possibility of missing a secondary tract

Inclusion criteria

• Age more than 18 years old.
• Both sexes.
• American Society of Anesthesiology (ASA) physical status I, II.
• Fistula in ano, Trans-sphincteric type

Exclusion criteria

• Patients with low perianal fistula.
• Recurrent perianal fistula.
• Associated anal conditions such as (piles, anal fissures, and rectal prolapse).
• Patients with inflammatory bowel disease or tuberculosis.
• Patients with acute perianal abscess.
• Patients with major incontinence.