Purpose: Fistula in ano is a begnin disease and should be treated like benign disease. We have used a technique of curating infected fistula lining, confirmed by fistuloscopy, and packing the tracts with collagen to reduce the dead space. Reporting our long-term outcomes were analyzed including procedural complications and fistula recurrence

Method: A retrospective analysis of collected data of the study conducted by a dedicated tertiary referral colorectal unit at a regional hospital in India between January 2010 and December 2019. Patients were included who underwent the procedure, the fistula curetting of the lining of the fistula tracts, clearing was confirmed with endoscopy and supplemented by instillation of sclerosant foam and a soft collagen. Internal opening < 1.5 cm closed with purse sting sutured. Larger opening of fistula was closed with a mucosal advancement anoplasty.

Results: The series of 189 patients with complex fistulae undergoing endofistula treatment comprising 102 highfistulas, 42 horse-shoe fistulas, 26 recurrent fistulas and 19 women with anterior fistulas. An internal opening was identifiable in all cases with 80.4% directly closed and remaining by advanced flap. The collagen extruded in 13.8% of cases usually from an intersphincteric tract extension. The primary healing rate (within 10 weeks) was 91.1% with 25 recurrences (13.2%) detected over a median follow-up of 72 months. Continence was maintained in all cases.

Conclusions: Customized curetting ablation confirmed by endoscopy is successful long-term in accurately identifying the tracts and the internal opening with satisfactory ablation and preservation of anal sphincter function. Minimum traumatic and minimum painful procedure,

Palak Thakrar