# Rerouting of the tract in the treatment of high anal fistula: a single-center experience

## TL;DR

This study evaluates rerouting as a treatment for high anal fistulas, finding it to be a safe and effective surgical option with low complication rates.

## Contribution

The study introduces rerouting as a novel surgical approach for high anal fistulas, combining benefits of fistulotomy and sphincter preservation.

## Key findings

- Rerouting had a 6.02% recurrence rate and low complication rates after 9 months of follow-up.
- Suprasphincteric fistulae and infection were identified as independent predictors of recurrence.
- The procedure combines advantages of fistulotomy and sphincter-preserving surgery.

## Abstract

High anal fistulae require more complicated treatment than low anal fistulae. Because of their complexity, this study aimed to assess the rerouting role in high anal fistulae treatment, as well as to assess recurrence and incontinence, and determine whether rerouting of the tract is a good option for treating high anal fistulae.

This is a prospective interventional study that was conducted on 83 patients with high perianal fistula, ranging in age from 18 to 72 years old, of both genders. All cases were assigned to history taking, laboratory investigations, clinical examination (general examination and local examination), and magnetic resonance imaging (MRI) for objective delineation of the fistulous tract and its association to the anal sphincters.

After a minimum follow-up period of 9 months, five cases (6.02%) experienced recurrence. Mild incontinence was reported in four patients (4.8%), while four patients (4.8%) developed infection. In addition, tract gangrene was observed in two patients (2.41%).In multivariate regression analysis, suprasphincteric fistulae and infection were independent predictors for recurrence.

After a minimum follow-up period of 9 months, five cases (6.02%) experienced recurrence. Mild incontinence was reported in four patients (4.8%), while four patients (4.8%) developed infection. In addition, tract gangrene was observed in two patients (2.41%).

In multivariate regression analysis, suprasphincteric fistulae and infection were independent predictors for recurrence.

The rerouting procedure is a feasible and safe surgical option for managing high transsphincteric perianal fistulae. It is associated with low postoperative complication rates, including short-term recurrence. It combines the advantages of fistulotomy and sphincter-preserving fistula surgery. However, further studies involving a large number of suprasphincteric fistula cases are needed to evaluate the efficacy of the rerouting technique in treating such fistulae.