Patterns and Outcomes of Treatment Failure after Ligation of Intersphincteric Fistula Tract for Cryptoglandular Anal Fistula: Analysis of 200 Failed Ligation of the Intersphincteric Fistula Tract Cases
Issued Date
2026-01-01
Resource Type
ISSN
00123706
eISSN
15300358
Scopus ID
2-s2.0-105029658167
Pubmed ID
41614593
Journal Title
Diseases of the Colon and Rectum
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SCOPUS
Bibliographic Citation
Diseases of the Colon and Rectum (2026)
Suggested Citation
Lohsiriwat V., Jitmungngan R., Wanitsuwan W., Sirikurnpiboon S., Chadbunchachai W., Chandrachamnong P., Ovartchaiyapong P. Patterns and Outcomes of Treatment Failure after Ligation of Intersphincteric Fistula Tract for Cryptoglandular Anal Fistula: Analysis of 200 Failed Ligation of the Intersphincteric Fistula Tract Cases. Diseases of the Colon and Rectum (2026). doi:10.1097/DCR.0000000000004142 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/115096
Title
Patterns and Outcomes of Treatment Failure after Ligation of Intersphincteric Fistula Tract for Cryptoglandular Anal Fistula: Analysis of 200 Failed Ligation of the Intersphincteric Fistula Tract Cases
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Abstract
BACKGROUND: – Despite generally favorable outcomes of ligation of intersphincteric fistula tract for anal fistula, several patients experience persistent or recurrent disease. OBJECTIVE: – This study aimed to identify patterns of treatment failure after ligation of intersphincteric fistula tract and evaluate their outcomes. DESIGN: – Multicenter retrospective study. SETTING: – Five university hospitals in Thailand. PATIENTS: – Those diagnosed with persistent or recurrent cryptoglandular anal fistula after ligation of intersphincteric fistula tract between 2012 and 2020. MAIN OUTCOME MEASURES: – Fistula characteristics, patterns of treatment failure and outcomes of subsequent management were analyzed. RESULTS: – A total of 200 patients were included, of whom 12.5% had persistent fistulas and 87.5% had recurrence. Median time to recurrence was 6 months (range, 1-48). Most treatment failures (n = 186, 93%) occurred within one year after surgery. Six distinct patterns of treatment failure were identified. The most common was type 1 (I–E, tract running from the previous internal opening (I) to an external opening (E) - known as an original fistula: n=116, 58%), followed by type 2 (I–L, tract running from the previous internal opening (I) to an unhealed intersphincteric wound - known as an intersphincteric fistula: n = 56, 28%). Type 1 failure was effectively treated by redo- ligation of intersphincteric fistula tract with an 87% success rate. Overall, the healing rate was 90.5% - with a median follow-up period of 18 months (range, 12-38). LIMITATIONS: – Exclusion of non-cryptoglandular fistulas may limit generalizability. The retrospective multicenter design and surgeon-dependent decision-making may have introduced selection bias and heterogeneity in surgical technique. CONCLUSIONS: – Most treatment failures occurred within one year after ligation of intersphincteric fistula tract. Understanding the six distinct failure patterns enables more appropriate surgical decision-making. The majority represented either recurrence of the original tract or persistence within the intersphincteric space. See Video Abstract.