Analysis of clinical data of 7 patients with complex high anal fistulas having supralevator rectal opening

[Objectives] To analyze the clinical data of patients with complex high anal fistulas having supralevator rectal opening (SRO), aiming to provide valuable insights for the clinical management of these patients. [Methods] We retrospectively analyzed the clinical data of 7 patients with complex high anal fistulas having SRO treated at the Department of Anorectal Diseases, Xi’an Hospital of Traditional Chinese Medicine, from June 2022 to May 2024. The surgical management of the primary fistulas and rectal branching fistulas, the location of the SRO, the length of postoperative hospital stay, and the outcomes of postoperative follow-up (including the formation of perianal abscesses or recurrence of anal fistulas) were evaluated. [Results] All 7 patients successfully underwent surgery. The surgical management of the primary fistulas involved transanal opening of the intersphincteric space (TROPIS) or fistulectomy/fistulotomy combined with seton drainage. Among the patients, 6 had SRO located on the lateral wall of the rectum, and 1 had SRO on the posterior wall. The surgical management of the rectal branching fistulas included excision and suturing, catheter drainage, or exclusion. The postoperative hospital stay ranged from 9 to 17 days for the 7 patients. The surgical wounds of primary fistulas and rectal branching fistulas healed within 3 months. During the 3 to 6 months of postoperative follow-up, no perianal abscesses or anal fistula recurrences were observed. [Conclusion] Patients with complex high anal fistulas having SRO could achieve favorable short-term outcomes with appropriate surgical treatment. The surgical management of primary fistulas and rectal branching fistulas should be comprehensively assessed based on the patient’s specific lesion characteristics and requires careful planning.