Extrasphincteric anal fistula with intrarectal opening extended upto thigh, successfully treated with a minimally invasive, novel surgical technique- a rare case report

• Published in: International journal of surgery case reports 2024-10, Vol.123, p.110259, Article 110259
• Main Authors: Bopparathi, Swapna, K.V, Narasimha Raju
• Format: Article
• Language: English
• Subjects: Anal fistula; Continence preservation; Internal opening; Ksharasutra; Recurrence; Retrograde probing
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2024.110259

Fistula in ano is a complex disease, and the treatment for it is still a big challenge for surgeons because of the high recurrence rate (7 %–50 %) and incontinence, and to minimize these complications numerous surgical interventions are emerging daily in the conventional system of medicine. A 48- year- old male patient came with complaints of pus discharge from an external opening in the inner aspect of his right thigh, located about 22 to 25 cm away from the anal verge for the last 15 years and was diagnosed as long extrasphincteric fistula with intrarectal opening based on clinical and MRI findings. We successfully treated this case with a minimally invasive novel surgical technique, RetroGrade Probing and Application of KharaSutra and Division of the Fistulous Tract (RGPAKS- DFT). Ksharasutra is a well-known method in the treatment of anal fistula for preserving continence and a low recurrence rate. Performing retrograde probing in every single case of anal fistula can address the involved anal gland under direct vision, which is essential for preventing recurrence and pairing retrograde probing with the division of the fistulous tract significantly reduces the treatment duration with minimal tissue loss. In fistula surgery, successful treatment relies on identifying the internal opening and eradicating the involved anal glands. Based on the same principle, this rare and complex anal fistula was effectively treated with this RGPAKS-DFT, resulting in no recurrence and incontinence in two years of follow–up after complete recovery. •Treatment of complex anal fistula is still a challenge to the operating surgeon because of its recurrence and incontinence.•The majority of complex fistulas don’t respond to standard treatment•Eradicating the involved anal gland is the ultimate treatment for anal fistula, and can be achieved by retrograde probing.•this procedure allows the surgeons to examine the shape, direction, site, number and nature of internal openings under direct vision.•Treatment of complex anal fistulas can be achieved with this innovative, minimally invasive technique, RGPAKS and DFT.