{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T13:54:37Z","timestamp":1789826077606,"version":"4.0.1"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,3,22]],"date-time":"2022-03-22T00:00:00Z","timestamp":1647907200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The optimal treatment of complex anal fistulas remains unclear, though many different sphincter-preserving procedures have been described. A minimally invasive technique with a better outcome is desired. The purpose of this study was to present a new technique\u2014sphincter-preserving fistulectomy (SPF) and its clinical outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>A retrospective study was performed to compare the efficacy and outcomes of SPF with ligation of the intersphincteric fistula tract (LIFT) in the management of complex anal fistulas in regards to postoperative pain, complications, wound healing time, recurrence, overall success rate, fecal continence function, and quality of life. Continence function was evaluated using the Wexner incontinence scale and anal manometry. The fecal incontinence quality of life (FIQL) scale was used to assess patients' quality of life.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>From June 2020 to July 2021, 41 patients with 43 SPF procedures and 35 patients with 35 LIFT procedures were included. Postoperative pain was comparable between two groups. The morbidity rate and the mean wound healing time in the SPF group were lower than those in the LIFT group (2.3% vs. 48.6%, <jats:italic>p<\/jats:italic> &amp;lt; 0.001; 1.4 \u00b1 0.3 vs. 1.7 \u00b1 0.4 months, <jats:italic>p<\/jats:italic> = 0.001). At a mean follow-up duration of 11.4 \u00b1 3.5 months in the SPF group and 10.7 \u00b1 4.3 months in the LIFT group, SPF achieved a better overall success rate than LIFT (97.7% vs. 77.1%, <jats:italic>p<\/jats:italic> = 0.014). Three patients in the SPF group and 4 patients in the LIFT group who all underwent a simultaneous fistulotomy procedure complained new incontinence of flatus. There was no statistical difference between the two groups in regards to the Wexner scores (<jats:italic>p<\/jats:italic> = 0.790), the maximum resting anal canal pressure (<jats:italic>p<\/jats:italic> = 0.641), the maximum squeeze pressure (<jats:italic>p<\/jats:italic> = 0.289), and the FIQL scores including lifestyle (<jats:italic>p<\/jats:italic> = 0.188), coping (<jats:italic>p<\/jats:italic> = 0.188), depression (<jats:italic>p<\/jats:italic> = 0.850), and embarrassment (<jats:italic>p<\/jats:italic> = 0.910).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>SPF is a novel, safe, and effective minimally invasive technique for the management of complex anal fistulas, with a promising success rate and negligible impairment on continence. Future prospective studies are needed to evaluate the long-term outcomes of SPF.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2022.832397","type":"journal-article","created":{"date-parts":[[2022,3,27]],"date-time":"2022-03-27T17:15:43Z","timestamp":1648401343000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":12,"title":["Sphincter-Preserving Fistulectomy Is an Effective Minimally Invasive Technique for Complex Anal Fistulas"],"prefix":"10.3389","volume":"9","author":[{"given":"Yinwen","family":"Hong","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhizhong","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingming","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinghui","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ke","family":"Wen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaopeng","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueliang","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,3,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1111\/codi.15429","article-title":"Long-term outcome of the Surgisis\u00ae (Biodesign\u00ae) anal fistula plug for complex cryptoglandular and Crohn's fistulas","volume":"23","author":"Aho F\u00e4lt","year":"2021","journal-title":"Colorectal Dis."},{"key":"B2","doi-asserted-by":"publisher","first-page":"855","DOI":"10.1007\/s00423-020-02024-5","article-title":"Effects of an anal fistula plug on anal function after surgery for treatment of a trans-sphincteric anal fistula","volume":"406","author":"Tao","year":"2021","journal-title":"Langenbecks Arch Surg."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1113","DOI":"10.1007\/s00384-019-03290-6","article-title":"Platelet-rich plasma (PRP) versus fibrin glue in cryptogenic fistula-in-ano: a phase III single-center, randomized, double-blind trial","volume":"34","author":"de la Portilla","year":"2019","journal-title":"Int J Colorectal Dis"},{"key":"B4","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1002\/sctm.19-0271","article-title":"Autologous adipose-derived stem cells for the treatment of complex cryptoglandular perianal fistula: a randomized clinical trial with long-term follow-up","volume":"9","author":"Garcia-Arranz","year":"2020","journal-title":"Stem Cells Transl Med."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1115","DOI":"10.1007\/s10151-021-02492-x","article-title":"VAAFT for complex anal fistula: a useful tool, however, cure is unlikely","volume":"25","author":"Chase","year":"2021","journal-title":"Tech Coloproctol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"741","DOI":"10.1007\/s10151-020-02213-w","article-title":"Video-assisted anal fistula treatment (VAAFT) for complex anorectal fistula: efficacy and risk factors for failure at 3-year follow-up","volume":"24","author":"Regusci","year":"2020","journal-title":"Tech Coloproctol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1016\/j.ijsu.2020.01.137","article-title":"Comparison of surgical outcomes between video-assisted anal fistula treatment and fistulotomy plus seton for complex anal fistula: a propensity score matching analysis\u2014retrospective cohort study","volume":"75","author":"Liu","year":"2020","journal-title":"Int J Surg."},{"key":"B8","doi-asserted-by":"publisher","first-page":"941","DOI":"10.1007\/s10151-021-02461-4","article-title":"Treatment of anal fistula with FiLaC\u00ae: results of a 10-year experience with 175 patients","volume":"25","author":"Giamundo","year":"2021","journal-title":"Tech Coloproctol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1007\/s00384-017-2779-7","article-title":"Rectal advancement flap for the treatment of complex cryptoglandular anal fistulas: a systematic review and meta-analysis","volume":"32","author":"Balciscueta","year":"2017","journal-title":"Int J Colorectal Dis."},{"key":"B10","doi-asserted-by":"publisher","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":"B11","doi-asserted-by":"publisher","first-page":"917","DOI":"10.1097\/SLA.0000000000001562","article-title":"Ligation of intersphincteric fistula tract vs ligation of the intersphincteric fistula tract plus a bioprosthetic anal fistula plug procedure in patients with transsphincteric anal fistula: early results of a multicenter prospective randomized trial","volume":"264","author":"Han","year":"2016","journal-title":"Ann Surg."},{"key":"B12","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/j.surg.2020.12.025","article-title":"Ligation of intersphincteric fistula tract (LIFT) with or without injection of platelet-rich plasma (PRP) in management of high trans-sphincteric fistula-in-ano: short-term outcomes of a prospective, randomized trial","volume":"170","author":"Madbouly","year":"2021","journal-title":"Surgery."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1534","DOI":"10.1097\/DCR.0000000000001691","article-title":"Video-assisted ligation of intersphincteric fistula tract for complex anal fistula: technique and preliminary outcomes","volume":"63","author":"Wanitsuwan","year":"2020","journal-title":"Dis Colon Rectum."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1081","DOI":"10.1007\/s00384-015-2430-4","article-title":"Marsupialization compared to open wound improves dressing change and wound care management after fistulectomy for low transsphincteric anal fistula","volume":"31","author":"Limongelli","year":"2016","journal-title":"Int J Colorectal Dis."},{"key":"B15","doi-asserted-by":"publisher","first-page":"e918228","DOI":"10.12659\/MSM.918228","article-title":"Clinical effect of tunnel-like fistulectomy plus draining seton combined with incision of internal opening of anal fistula (TFSIA) in the treatment of high trans-sphincteric anal fistula","volume":"26","author":"Yan","year":"2020","journal-title":"Med Sci Monit."},{"key":"B16","doi-asserted-by":"publisher","first-page":"792","DOI":"10.1016\/j.asjsur.2018.12.005","article-title":"One stage fistulectomy for high anal fistula with reconstruction of anal sphincter without fecal diversion","volume":"42","author":"Farag","year":"2019","journal-title":"Asian J Surg."},{"key":"B17","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1080\/00015458.2020.1753151","article-title":"Fistulectomy and primary sphincteroplasty (FIPS) to prevent keyhole deformity in simple anal fistula: a single-center retrospective cohort study","volume":"121","author":"De Hous","year":"2021","journal-title":"Acta Chir Belg."},{"key":"B18","doi-asserted-by":"publisher","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":"B19","doi-asserted-by":"publisher","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":"B20","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1007\/BF02237236","article-title":"Fecal incontinence quality of life scale: quality of life instrument for patients with fecal incontinence","volume":"43","author":"Rockwood","year":"2000","journal-title":"Dis Colon Rectum."},{"key":"B21","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1111\/codi.14405","article-title":"Long-term outcomes and quality of life following ligation of the intersphincteric fistula tract for high transsphincteric fistulas","volume":"21","author":"Sun","year":"2019","journal-title":"Colorectal Dis."},{"key":"B22","doi-asserted-by":"publisher","first-page":"932","DOI":"10.1111\/codi.15452","article-title":"High failure rates following ligation of the intersphincteric fistula tract for transsphincteric anal fistulas: are preoperative MRI measurements of the fistula tract predictive of outcome?","volume":"23","author":"Sarmiento-Cobos","year":"2021","journal-title":"Colorectal Dis."},{"key":"B23","doi-asserted-by":"publisher","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":"B24","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1007\/s00384-016-2723-2","article-title":"Effective and long-term outcome following ligation of the intersphincteric fistula tract (LIFT) for transsphincteric fistula","volume":"32","author":"Chen","year":"2017","journal-title":"Int J Colorectal Dis."},{"key":"B25","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1097\/DCR.0b013e31823c0f74","article-title":"Is it possible to improve the outcome of transanal advancement flap repair for high transsphincteric fistulas by additional ligation of the intersphincteric fistula tract?","volume":"55","author":"van Onkelen","year":"2012","journal-title":"Dis Colon Rectum."},{"key":"B26","doi-asserted-by":"publisher","first-page":"1041","DOI":"10.1111\/codi.13161","article-title":"The cryptoglandular theory revisited","volume":"17","author":"Gosselink","year":"2015","journal-title":"Colorectal Dis."},{"key":"B27","doi-asserted-by":"publisher","first-page":"1231","DOI":"10.1097\/DCR.0000000000001448","article-title":"Ligation of the intersphincteric fistula tract for high transsphincteric fistula yields moderate results at best: is the tide turning?","volume":"62","author":"G\u00f6ttgens","year":"2019","journal-title":"Dis Colon Rectum."},{"key":"B28","doi-asserted-by":"publisher","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."}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.832397\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,27]],"date-time":"2022-03-27T17:15:45Z","timestamp":1648401345000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.832397\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,22]]},"references-count":28,"alternative-id":["10.3389\/fsurg.2022.832397"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2022.832397","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,22]]},"article-number":"832397"}}