Intersphincteric Approach to Perianal Fistula With High Risk for Postoperative Fecal Incontinence

.Rerouting operation takes the advantage of minimal recurrence rate as well as minimal incontinence that is associated with less sphincter division,It is indicated in patients with transsphincteric fistula in whom lay open is expected to be associated with significant incontinence .

Lay open is the classic surgical management for Peri Anal fistula,however division of significant portion of anal sphincter may be divided with postoperative fecal incontinence,Many surgical techniques have been described for sphincter preservation ,But unfortunately associated high recurrence rate.Rerouting operation takes the advantage of minimal recurrence rate as well as minimal incontinence that is associated with less sphincter division,It is indicated in patients with transsphincteric fistula in whom lay open is expected to be associated with significant incontinence .The operation is done in tow stages ,the first is to mobilize the transsphincteric part into the inter sphincteric plane thus converting it to intersphincteric fistula which is then laid open , with division of internal sphincter with preserving external sphincter.

Rerouting technique done in patients with high transsphincteric fistula or with high internal opening.

Rerouting technique decrease incidence of fecal incontinice after high transsphincteric perianal fistula surgery .

Inclusion Criteria: High arching transsphincteric fistula Transsphincteric fistula with high internal opening Transsphincteric fistula with short anal canal. Horseshoe perianal fistula fulfilling above criteria. Exclusion Criteria: Transsphincteric fistula. Low perianal fistula.