Minimal Sphincter Sacrificing Procedures in the Management of horseshoe Perianal Fistula

Abstract

Perianal fistula is an abnormal communication between the epithelialized surface of the anorectal canal and usually, the perianal skin. It is a morbid condition commonly occurs following perianal abscess drainage due to cryptoglandular infection. Symptoms generally affect quality of life significantly, and they range from minor discomfort and drainage with resultant hygienic problems to sepsis (Corman et al., 2013). Several classification systems have been developed in an attempt to quantify disease extent and severity of the disease, which will guide management. Horseshoe perianal fistula is a complex type of trans-sphincteric perianal fistula that is caused by infection in the perianal gland present in the midline posteriorly. Infection in this particular site can extend along the deep postanal space to reach the ischiorectal fossa in one or either side of the anal canal before it drains in the perianal skin (Ustynoski et al., 1990). Horseshoe fistula remains a complex and challenging clinical entity. The treatment is surgical with the major objectives being (1) successful elimination of the disease, (2) minimizing the recurrence rate, (3) achieving cure in a timely manner, and (4) preservation of sphincter function (Kaiser, 2008). Surgical management is the mainstay of treatment.Many methods have been proposed for the treatment of anal fistulae in general and horseshoe fistula in particular; however, an aggressive approach (lay open) is known to result in a decreased rate of recurrence but an increased risk of postoperative functional complications as incontinence. Decreasing the rate of recurrence and keeping the function of anal sphincter are the goals when treating fistulae (Athanasiadis et al., 2004).