Management of Complex Posterior Horseshoe Anal Fistula by The Modified Hanley’s Procedure -Clinical Experience and Review of 25 Patients

Abstract

This is a prospective study carried out with the aim to document clinical experience in the surgical management of posterior horseshoe fistula of cryptoglandular origin using the modified Hanley procedure as a one-stage procedure. In this study, A modified Hanley procedure was used in 25 patients (20 males and 5 females) who had presented with posterior horseshoe anal fistula (mean age 41 years) for the period from February 2020 to December 2022, and the results of surgical outcomes were analysed. In this procedure, after optimization and anaesthesia, a malleable probe is inserted into the primary Fistulous tract and directed toward the posterior anal space. A straight transverse incision is placed at the primary opening, towards the tip of the coccyx and posterior anal space. The anal portion of the fistulous tract is unroofed. The side fistula tracts are unroofed and removed in toto. It is noted complete healing was achieved in all 25 patients within three months postoperative period. Recurrence was found in only three patients after six-month follow-up period. All patients were discharged on the 5th post-operative day None required readmission and post-operative pain was mild and bearable. Narcotic analgesics were not needed after discharge. After undergoing the procedure, the patients fully recovered and within 2-3 weeks all patients were able to return to their work and daily activity. In conclusion, the posterior complex horseshoe anal fistula, though it has a treacherous fistulous tract can be safely and successfully treated using the modified Hanley's procedure.