Treatment of trans-sphincteric
fistula is usually a compromise between recurrence and incontinence. Dermal
island flap anoplasty has been found to be useful in the treatment of these
fistulas. We performed a randomized trial to compare dermal
island flap anoplasty with conventional treatment for trans-sphincteric
fistula-in-ano. Seventy nine patients with
fistula-in-ano were recruited; twenty patients with trans-sphincteric
fistula confirmed by endoanal ultrasound were prospectively randomized to receive either dermal
island flap anoplasty (IFA) or conventional treatment (CVN) for trans-sphincteric
fistula-inano. Conventional treatment consisted of lay open fistulotomy or seton insertion if deemed unsuitable for fistulotomy. Dermal
island flap anoplasty involved a cutaneous advancement flap into the rectum.
Pain scores,
fecal incontinence scores, operative complications, wound healing and recurrence rates were charted. Two patients in the CVN group required seton insertions, which were still intact at the 9-month follow-up. Two patients with similar high trans-sphincteric
fistula in the IFA group avoided having a long-term seton. There were no differences in the
postoperative pain score, incontinence score, complications, wound healing and recurrence rates between the two groups. IFA is a safe and useful method for treating transsphincteric
fistula. It can be considered when a suprasphincteric extension is suspected, thus avoiding risk of incontinence or the discomfort of a long-term seton.