[Full-wall semi-circular mobilization of posterior wall of the lower ampullar rectum for complex recurrent anorectal fistula].

Objective: To describe a new technique for closure of sphincter complex defects after excision of recurrent high rectal fistulas and compare with other traditional techniques.
Material and Methods: We retrospectively analyzed patients operated on for recurrent posterior rectal fistula. All patients underwent fistulectomy and one of the methods for defect closure after excision of the fistula: sphincter suturing, muco-muscular flap or full-wall semicircular mobilization of the lower ampullar rectum. The last method implemented the principle of inter-sphincter resection in rectal cancer. We developed this method as an alternative to muco-muscular flap in patients with fibrosis of anal canal to form a full-thickness well-vascularized flap without tissue tension.
Results: Between 2019 and 2021, 6 patients underwent fistulectomy with sphincter suturing, 5 patients - closure with muco-muscular flap, 3 males underwent full-wall semicircular mobilization of the lower ampullar rectum. There was a tendency to better continence after a year (1 (0, 1.5), 1 (0, 1.5) and 3 (1, 3) points, respectively). Postoperative follow-up period was 12.5 (10, 15), 12 (9, 15) and 16 (12, 19) months, respectively. None patient had signs of recurrence throughout the follow-up period.
Conclusion: Original technique can be considered as an alternative to standard approaches in patients with high recurrent posterior anorectal fistulas, when traditional displaced endorectal flap is ineffective or impossible due to excessive scarring and anatomical changes in the anal canal.