{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T18:10:39Z","timestamp":1774635039302,"version":"3.50.1"},"reference-count":30,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2025,1,18]],"date-time":"2025-01-18T00:00:00Z","timestamp":1737158400000},"content-version":"vor","delay-in-days":17,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Sixth Affiliated Hospital of Sun Yat-Sen University Clinical Research"},{"name":"Program of Guangdong Provincial Clinical Research Center for Digestive Diseases","award":["2020B111117004"],"award-info":[{"award-number":["2020B111117004"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background and aim<\/jats:title>\n                  <jats:p>High complex anal fistula is a clinical challenge for proctologists and a nightmare for patients. Although the sphincter-sparing approach seems an ideal surgical intervention, there remains room for improvement in treatment efficacy. Herein, we introduce an enhanced sphincter-sparing approach, namely the fistula occlusion with the internal sphincter flap (FOISF), for treating high complex anal fistulas.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This study evaluated 15 patients with high complex anal fistulas who underwent FOISF between October 2021 and December 2022 in the Sixth Affiliated Hospital, Sun Yat-sen University (Guangzhou, P. R. China). Data on success rates, anal function, and various surgical characteristics were subjected to rigorous analysis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>All patients underwent the FOISF procedure, with a median operation time of 53\u2009min. Fourteen patients achieved primary intention healing, while one patient healed by second intention. No recurrence was observed over a follow-up period of 14\u201330\u2009months. All patients exhibited satisfactory anal continence, with no statistically significant difference observed between preoperative and postoperative Wexner scores (P\u2009=\u20090.331). A significant improvement in the quality of life was observed when compared with the preoperative assessment (P\u2009&amp;lt;\u20090.001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The preliminary results of the FOISF procedure present an effective approach to treat high complex anal fistula.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/gastro\/goaf006","type":"journal-article","created":{"date-parts":[[2025,1,18]],"date-time":"2025-01-18T16:44:47Z","timestamp":1737218687000},"source":"Crossref","is-referenced-by-count":2,"title":["Preliminary results of a novel sphincter-sparing technique\u2014fistula occlusion with the internal sphincter flap (FOISF)\u2014for high complex anal fistulas"],"prefix":"10.1093","volume":"13","author":[{"given":"Dandan","family":"Huang","sequence":"first","affiliation":[{"name":"Department of General Surgery (Coloproctology), The Sixth Affiliated Hospital, Sun Yat-sen University , Guangzhou, Guangdong,","place":["P. R. China"]},{"name":"Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University , Guangzhou, Guangdong,","place":["P. R. China"]},{"name":"Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University , Guangzhou, Guangdong,","place":["P. R. China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ning","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University , Guangzhou, Guangdong,","place":["P. R. China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yiping","family":"Li","sequence":"additional","affiliation":[{"name":"Department of General Surgery (Coloproctology), The Sixth Affiliated Hospital, Sun Yat-sen University , Guangzhou, Guangdong,","place":["P. R. China"]},{"name":"Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University , Guangzhou, Guangdong,","place":["P. R. China"]},{"name":"Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University , Guangzhou, Guangdong,","place":["P. R. China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donglin","family":"Ren","sequence":"additional","affiliation":[{"name":"Department of General Surgery (Coloproctology), The Sixth Affiliated Hospital, Sun Yat-sen University , Guangzhou, Guangdong,","place":["P. R. China"]},{"name":"Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University , Guangzhou, Guangdong,","place":["P. R. China"]},{"name":"Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University , Guangzhou, Guangdong,","place":["P. R. China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yong","family":"Yang","sequence":"additional","affiliation":[{"name":"Anorectal Department, Xuzhou Central Hospital , Xuzhou, Jiangsu,","place":["P. R. China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaikai","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University , Guangzhou, Guangdong,","place":["P. R. China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yanzhu","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Anorectal Surgery, The People\u2019s Hospital of Zhongshan , Zhongshan, Guangdong,","place":["P. R. China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhimin","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of General Surgery (Coloproctology), The Sixth Affiliated Hospital, Sun Yat-sen University , Guangzhou, Guangdong,","place":["P. R. China"]},{"name":"Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University , Guangzhou, Guangdong,","place":["P. R. China"]},{"name":"Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University , Guangzhou, Guangdong,","place":["P. R. China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,1,18]]},"reference":[{"key":"2025081215090846300_goaf006-B1","doi-asserted-by":"crossref","first-page":"12","DOI":"10.3748\/wjg.v21.i1.12","article-title":"Modern management of anal fistula","volume":"21","author":"Limura","year":"2015","journal-title":"World J Gastroenterol"},{"key":"2025081215090846300_goaf006-B2","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1111\/j.1463-1318.2008.01483.x","article-title":"Surgical management of anal fistulae: a systematic review","volume":"10","author":"Malik","year":"2008","journal-title":"Colorectal Dis"},{"key":"2025081215090846300_goaf006-B3","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.1007\/s10151-021-02525-5","article-title":"External sphincter-sparing anal fistulotomy (ESSAF): a simplified technique for the treatment of fistula-in-ano","volume":"25","author":"Parnasa","year":"2021","journal-title":"Tech Coloproctol"},{"key":"2025081215090846300_goaf006-B4","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1007\/BF02554093","article-title":"Mucosal advancement in the treatment of anal fistula","volume":"28","author":"Aguilar","year":"1985","journal-title":"Dis Colon Rectum"},{"key":"2025081215090846300_goaf006-B5","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1007\/s00384-005-0060-y","article-title":"Meta-analysis of randomized clinical trials comparing drainage alone vs primary sphincter-cutting procedures for anorectal abscess-fistula","volume":"21","author":"Quah","year":"2006","journal-title":"Int J Colorectal Dis"},{"key":"2025081215090846300_goaf006-B6","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1007\/s10151-009-0522-2","article-title":"LIFT procedure: a simplified technique for fistula-in-ano","volume":"13","author":"Rojanasakul","year":"2009","journal-title":"Tech Coloproctol"},{"key":"2025081215090846300_goaf006-B7","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.ijsu.2017.02.095","article-title":"Transanal opening of intersphincteric space (TROPIS)\u2014a new procedure to treat high complex anal fistula","volume":"40","author":"Garg","year":"2017","journal-title":"Int J Surg"},{"key":"2025081215090846300_goaf006-B8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/bjs.1800630102","article-title":"A classification of fistula-in-ano","volume":"63","author":"Parks","year":"1976","journal-title":"Br J Surg"},{"key":"2025081215090846300_goaf006-B9","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1007\/BF02050307","article-title":"Etiology and management of fecal incontinence","volume":"36","author":"Jorge","year":"1993","journal-title":"Dis Colon Rectum"},{"key":"2025081215090846300_goaf006-B10","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1097\/DCR.0000000000000877","article-title":"Design and psychometric evaluation of the quality of life in patients with anal fistula questionnaire","volume":"60","author":"Ferrer-M\u00e1rquez","year":"2017","journal-title":"Dis Colon Rectum"},{"key":"2025081215090846300_goaf006-B11","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1016\/j.surg.2019.09.012","article-title":"Ligation of intersphincteric fistula tract (LIFT) in treatment of anal fistula: an updated systematic review, meta-analysis, and meta-regression of the predictors of failure","volume":"167","author":"Emile","year":"2020","journal-title":"Surgery"},{"key":"2025081215090846300_goaf006-B12","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1111\/codi.12104","article-title":"Efficacy of LIFT for recurrent anal fistula","volume":"15","author":"Lehmann","year":"2013","journal-title":"Colorectal Dis"},{"key":"2025081215090846300_goaf006-B13","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1097\/DCR.0000000000000880","article-title":"Ligation of intersphincteric fistula tract for fistula in ano: lessons learned from a decade of experience","volume":"60","author":"Malakorn","year":"2017","journal-title":"Dis Colon Rectum"},{"key":"2025081215090846300_goaf006-B14","doi-asserted-by":"crossref","first-page":"374","DOI":"10.4240\/wjgs.v14.i5.374","article-title":"Comparison between recent sphincter-sparing procedures for complex anal fistulas-ligation of intersphincteric tract vs transanal opening of intersphincteric space","volume":"14","author":"Garg","year":"2022","journal-title":"World J Gastrointest Surg"},{"key":"2025081215090846300_goaf006-B15","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.1111\/codi.15555","article-title":"Transanal opening of the intersphincteric space: a novel sphincter-sparing procedure to treat 325 high complex anal fistulas with long-term follow-up","volume":"23","author":"Garg","year":"2021","journal-title":"Colorectal Dis"},{"key":"2025081215090846300_goaf006-B16","doi-asserted-by":"crossref","first-page":"1814","DOI":"10.1007\/s11605-022-05384-z","article-title":"TROPIS (transanal opening of intersphincteric space) procedure for the treatment of horseshoe anal fistulas","volume":"26","author":"Garg","year":"2022","journal-title":"J Gastrointest Surg"},{"key":"2025081215090846300_goaf006-B17","doi-asserted-by":"crossref","first-page":"4020","DOI":"10.3748\/wjg.v21.i13.4020","article-title":"PERFACT procedure: a new concept to treat highly complex anal fistula","volume":"21","author":"Garg","year":"2015","journal-title":"World J Gastroenterol"},{"key":"2025081215090846300_goaf006-B18","first-page":"744","article-title":"The treatment of fistula in ano: with especial reference to the whitehead operation","volume":"56","author":"Elting","year":"1912","journal-title":"Ann Surg"},{"key":"2025081215090846300_goaf006-B19","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/S1091-255X(97)80138-2","article-title":"Endorectal mucosal advancement flap: the preferred method for complex cryptoglandular fistula-in-ano","volume":"1","author":"Golub","year":"1997","journal-title":"J Gastrointest Surg"},{"key":"2025081215090846300_goaf006-B20","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1177\/000313480807401008","article-title":"Long-term outcome of endorectal advancement flap for complex anorectal fistulae","volume":"74","author":"Abbas","year":"2008","journal-title":"Am Surg"},{"key":"2025081215090846300_goaf006-B21","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1177\/000313480407001022","article-title":"Endorectal flap advancement repair is an effective treatment for selected patients with anorectal fistulas","volume":"70","author":"Dixon","year":"2004","journal-title":"Am Surg"},{"key":"2025081215090846300_goaf006-B22","doi-asserted-by":"crossref","first-page":"1622","DOI":"10.1007\/s10350-004-7249-y","article-title":"Outcomes of primary repair of anorectal and rectovaginal fistulas using the endorectal advancement flap","volume":"45","author":"Sonoda","year":"2002","journal-title":"Dis Colon Rectum"},{"key":"2025081215090846300_goaf006-B23","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1007\/BF02554276","article-title":"The use of transanal rectal advancement flaps in the management of fistulas involving the anorectum","volume":"30","author":"Jones","year":"1987","journal-title":"Dis Colon Rectum"},{"key":"2025081215090846300_goaf006-B24","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.1007\/BF02235039","article-title":"Transanal advancement flap repair of transsphincteric fistulas","volume":"42","author":"Schouten","year":"1999","journal-title":"Dis Colon Rectum"},{"key":"2025081215090846300_goaf006-B25","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1089\/lap.2021.0425","article-title":"Predictive risk factors of the conversion from video-assisted treatment of anal fistula to seton fistulotomy","volume":"32","author":"Zhang","year":"2022","journal-title":"J Laparoendosc Adv Surg Tech A"},{"key":"2025081215090846300_goaf006-B26","doi-asserted-by":"crossref","first-page":"636952","DOI":"10.5402\/2011\/636952","article-title":"Treatment of complex fistula in ano with cable-tie seton: a prospective case series","volume":"2011","author":"Memon","year":"2011","journal-title":"ISRN Surg"},{"key":"2025081215090846300_goaf006-B27","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1177\/0003134821989048","article-title":"Transanal opening of intersphincteric space for fistula-in-ano","volume":"88","author":"Li","year":"2022","journal-title":"Am Surg"},{"key":"2025081215090846300_goaf006-B28","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.ijsu.2010.03.009","article-title":"Treatment of anal fistulas by partial rectal wall advancement flap or mucosal advancement flap: a prospective randomized study","volume":"8","author":"Khafagy","year":"2010","journal-title":"Int J Surg"},{"key":"2025081215090846300_goaf006-B29","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1007\/s10151-015-1323-4","article-title":"Fistulotomy or fistulectomy and primary sphincteroplasty for anal fistula (FIPS): a systematic review","volume":"19","author":"Ratto","year":"2015","journal-title":"Tech Coloproctol"},{"key":"2025081215090846300_goaf006-B30","doi-asserted-by":"crossref","first-page":"3073","DOI":"10.1111\/codi.15945","article-title":"Is fistulotomy with immediate sphincter reconstruction (FISR) a sphincter preserving procedure for high anal fistula? A systematic review and meta-analysis","volume":"23","author":"Iqbal","year":"2021","journal-title":"Colorectal Dis"}],"container-title":["Gastroenterology Report"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/gastro\/article-pdf\/doi\/10.1093\/gastro\/goaf006\/61492343\/goaf006.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/gastro\/article-pdf\/doi\/10.1093\/gastro\/goaf006\/61492343\/goaf006.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T19:09:16Z","timestamp":1755025756000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/gastro\/article\/doi\/10.1093\/gastro\/goaf006\/7960135"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025]]},"references-count":30,"URL":"https:\/\/doi.org\/10.1093\/gastro\/goaf006","relation":{},"ISSN":["2052-0034"],"issn-type":[{"value":"2052-0034","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025]]},"published":{"date-parts":[[2025]]},"article-number":"goaf006"}}