Fistula in ano: a new surgical technique

Muthanna Medical Journal
Volume 5, Issue 1, June 2018, Pages 40-48

Research Article

Imad Diame Dhahir Al-Hasani¹*, Sahar Swadi Raheem

* Correspondence author:
¹Al Muthanna University/College of Medicine
Received 27 January 2018, Accepted 03 April 2018, Available online 20 April 2018.
This is article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright © 2018IH


The aim of this study is to presented a new technique in surgical management, we called it MELT (multiple encircling ligatures around intersphincteric tract of fistula). The study was done between April 2012 to April 2015 and includes all patients with complex high transphincteric and recurrent fistulas. Study includes all age groups and both genders. Operative details are recorded and compared with other well-known procedures. Post-operative outcomes were analyzed. Out of 56 cases, 41 were males (69%) and 17 were females (31%), with mean age group of 38 years. 10 (18%) cases are recurrent complex fistulas and the rest are high transphincteric type around anorectal ring. Recurrence recorded in 5 cases (9%), mild incontinence reported in 6 cases (11%), no major incontinence occurred, 2 cases of mild bleeding and two cases of post-operative urine retention during 18 months of post-operative follow up. We concluded that our technical easier with relatively lower complication rates in comparison with other well-known surgical operations for fistula-in-ano.

Key words: Complex; Transphincteric; Fistula-in-ano; MELT