The Outcomes Fistulectomy with Immediate Sphincter Repair for Treatment of High Trans-sphincteric Anal Fistula: Experience from a Low-Resource setting Hospital.

Background Managing high trans-sphincteric anal fistulas is challenging due to the need to prevent recurrence while preserving sphincter function. Fistulectomy combined with immediate sphincter repair may offer a balanced approach to achieving these objectives. Objectives This study evaluates the short-term outcomes of fistulectomy with sphincteroplasty in treating high trans-sphincteric anal fistulas. Methods We conducted a prospective observational study of patients undergoing fistulectomy with immediate sphincter repair for high trans-sphincteric anal fistula between June 2019 and May 2021. Demographic data, perioperative pain scores, hospital stay length, and Wexner incontinence scores were recorded for analysis. Results A total of 107 patients met the inclusion criteria, with 80 (74.3%) male participants and a median age of 40 years (range: 18–66). Among them, eight (7.4%) were on steroids, and twelve (11.2%) had diabetes mellitus. Seven (6.5%) had a history of anal conditions or surgeries. Post-operatively, one patient (0.9%) experienced minor bleeding that resolved spontaneously. Additional analgesia was required for six (5.6%) patients on the first post-operative day, and two patients developed surgical site infections that were managed with simple dressings. Most participants resumed normal activities within a week. Anal stenosis occurred in one (0.9%) patient and improved with a single anal dilatation session. Chronic anal pain was reported by four (3.7%) patients, gas incontinence by one (0.9%), and pruritus ani by four (3.7%). The majority of wounds healed within one month. Conclusions Fistulectomy with immediate sphincter repair is a safe and feasible option for treating high trans-sphincteric anal fistulas in Sudan, with an acceptable rate of complications and promising short-term outcomes.