Low Transsphincteric Anal Fistula: Limited Fistulectomy and Placement of a Draining Seton in a Two-Stage Therapeutic Strategy

We report the case of a 45-year-old patient with no significant past medical history who was admitted for anal pain associated with discharge. Clinical examination identified an inflamed para-anal external opening, and endoanal exploration demonstrated a low internal opening consistent with a low transsphincteric anal fistula. The procedure was performed under spinal anesthesia in the gynecologic position. The first-stage surgical management consisted of limited fistulectomy of the inflamed external component followed by placement of a loose draining seton across the residual transsphincteric segment. The immediate postoperative course was uneventful. A second-stage procedure is planned depending on local evolution, either by FiLaC® or by targeted fistulotomy with seton removal.