Cutting of Intersphincteric Space Is Effective Anal Fistula Treatment

Qin J, Wu Y, Zheng X, et al. Comparative Evaluation Between Cutting of the Intersphincteric Space Vs. Cutting Seton in High Anal Fistula: A Randomized Controlled Trial. J Am Coll Surg. 2024, in press.

Wexner S. The Quest for the Panacea Treatment for Anal Fistula. J Am Coll Surg. 2024, in press.

Anal fistula is defined as an epithelialized tract connecting the anal canal to the skin, and symptoms include persistent infection with purulent drainage and severe pain. High anal fistula is usually treated by placing a cutting seton (CS) in the fistula tract. While this treatment provides adequate infection control, it is associated with significant pain and anal sphincter damage leading to incontinence.

This study describes a procedure called “cutting of the intersphincteric space” (COIS) that opens the intersphincteric space via a skin incision allowing drainage of the infection and debridement of necrotic tissue. The procedure is illustrated in the article.

The article provided outcomes of a randomized, prospective trial comparing COIS and CS in 72 patients treated in a single institution in China. The main outcome of interest was wound healing time; other important outcomes included anal sphincter function, wound pain, and fistula recurrence. Follow-up was available out to 12 months.

Wound healing time was significantly shorter in the COIS group; anal sphincter function and incontinence scores were significantly better as well. The authors concluded that COIS was an effective treatment for high, complex, anal fistula.

In the editorial that accompanied the article, Wexner congratulated the authors for conducting this trial and noted that COIS could well replace CS as the preferred procedure for treatment of high anal fistula. He emphasized that additional data including long-term outcomes are needed.