Complementary thermo-obliteration in double anal fistula

Anal fistula is an abnormal tract or cavity originating in a cryoglandular infection, whose primary internal opening is in the anorectal junction. Secondary orifice is located in the perianal skin, perineum or vagina. We undertook this study to use an electrosurgery complementary procedure that treats multiple tracts without sectioning the anal sphincter. We reviewed the files of 1354 patients who were operated on for anal fistula in the Regional Hospital of the Ecuadorian Institute of Social Security, Guayaquil, Ecuador, from January 1978 to December 2002. We selected only 79 patients with diagnoses of double anal fistula. Study design was descriptive, retrospective, and longitudinal. Seventy one patients were male (89.8%). The age average was 42.5 years. The symptomatic period had an average of 14 months. The period of wound healing and incapacity from work was 3.3 weeks. The procedure failed in seven patients (8.8%) and eight patients presented partial incontinence to gases (10.12%). Fulguration is a coagulation method in which the active electrode is maintained near the tissue (1-10 mm distance) and the energy dissipated in the area by means of sparks. Fulguration has greater penetration capability and reaches a greater degree of dehydration of the tissue than electrocoagulation. Factors that influence recurrence and anal incontinence are, for recurrence: type of fistula, horseshoe extension, identification of the primary orifice, previous anal surgery and surgeon's experience. Incontinence has been related to female gender, high anal fistulas, and type of previous surgery (fistulectomy/fistulotomy). In complex double anal fistulas, it is preferable to resect the tract and use complementary thermo-obliteration. In this way, anal continence is not altered substantially.