Modified Hanley Procedure for Management of Complex Posterior Horseshoe Anal Fistula

Abstract

Background: An anorectal fistula is a connection that is not normal among the epithelialized surface of the anal canal and most  commonly the skin of the perianal region or the perineum. Surgery is the mainstay therapy aiming to drain local infection, to eliminate  the fistulous tract and to avoid its recurrence while maintaining the function of the sphincter.

Aim: This study aimed to evaluate the  treated patients with horseshoe fistula of cryptoglandular origin utilizing a modified Hanley method involving a hybrid cutting one-stage  approach.

Methods: This prospective trial was done on twenty cases with chronic horseshoe fistula. All patients were subjected to  preoperative PR examination to check for sphincter tone, preoperative MRI to demonstrate the extent of fistula and the deep post-anal  space affection.

Results: Regarding type of fistula, 3 (15%) persons had high trans-sphincteric fistula & 17 (85%) patients had low trans- sphincteric fistula. Seven (35%) patients had external opening from the anal verge within three centimetres and 13 (65%) patients had  external opening from the anal verge beyond 3 cm. Out of the total number of individuals, three individuals (15%) had an internal  opening located at the dentate line, while the remaining 17 individuals (85%) had an internal opening situated above the dentate line.  Four (20%) patients had recurrence. Complete healing was achieved in all cases at 12 weeks post-operative period.

Conclusions: The  modified Hanley operation is effective and conservative surgical procedure that eliminates the disadvantage of keeping the seton for a  long period and preserve the sphincter function.