Fistulotomy Around The Sphincter (FATS) Procedure: A Simple New Sphincter-Sparing Concept to Treat High Fistula-In-Ano PR01-PR03
Dr. Pankaj Garg,
Garg Fistula Research Institute, 1041/15, Panchkula-134113, Haryana, India.
Fistulotomy Around The Sphincter (FATS) is a novel sphincter sparing procedure for high anal fistulas. In FATS procedure, the fistula tract from internal opening to external opening is laid open except that the sphincter complex is not cut and is completely preserved. The fistula tract passing through the sphincter complex (TISC-Tract Inside Sphincter Complex) is thoroughly cleaned, curetted and debrided but is not widened. The final wound should form a double cone, one each at internal as well as external opening. The wide end of the cone should be at the mucosa and the skin respectively whereas TISC should form the tip of both the cones. The wound heals by secondary intention (granulation tissue). The aim is that TISC heals first. Subsequently, both the wounds at the internal and the external openings heal, from TISC towards the respective openings. This article is about three patients with high fistula-in-ano in whom FATS was done. All of the three patients were males with a mean age of 43.0±0.5 years and with a median follow-up of 8 months. The fistula healed in all patients with no change in incontinence scores (Vaizy’s incontinence scores). FATS is a simple and effective novel sphincter-sparing procedure to treat high fistula-in-ano especially with wide internal opening.