Relocation and silastic tension only (RASTO) procedure for very long anal fistula tracts: Initial case series with results of a new surgical technique

Abstract

BackgroundThere is no consensus regarding the best treatment for very long anal fistula tracts, greater than 12 cm in length. Study designA retrospective study was performed of a new method. Any abscess was drained. The fistula was relocated near the anal opening by making a new skin incision that was dissected into the fistula tract. A fistulotomy of the original tract was not performed. Three silastic bands were passed into the internal anal fistula orifice and out the new skin incision. One band was tightened down, and the tension from the tight silastic band acted as a cutting seton over several weeks. The original fistula tract which had been diverted from contamination healed without additional treatments. All patients had follow up examination, were assessed for fistula healing, followed for recurrence, and questioned with the SF 36. ResultsSeventeen fistulas were treated. There were 2 suprasphincteric, 0 extrasphincteric, 2 intersphincteric, and 13 transsphincteric. Five chronic and 12 were acute fistulas with abscesses. After 2–3 weeks, the previously tightened cutting seton was removed, and another seton was tightened down. After another 2 weeks, 60% of the patients had the seton cut all the way through and fall out. The remaining needed either tightening of the remaining seton, or fistulotomy of remaining superficial tissue. All fistulas healed without recurrence, and none of the patients developed incontinence of stool. ConclusionTreatment of acute and chronic fistula in ano using relocation and silastic tension only (RASTO) is very successful for long anal fistulas and allows fistula healing in 4–9 weeks without additional treatments and avoids a very long fistulotomy.