ORIGINAL RESEARCH article
Front. Surg.
Sec. Colorectal and Proctological Surgery
This article is part of the Research TopicManagement Strategies for Chronic Anal Fissures and Anal Fistulas: Efficacy and SafetyView all articles
A Randomized Controlled Study on the Efficacy and Function of Internal Sphincter Lowering Combined with External Sphincter Denudation and Virtual Hanging Drainage in the Treatment of Complex Anal Fistula
Provisionally accepted
- 1Suqian First People's Hospital, Suqian, China
- 2Suqian Hospital of Traditional Chinese Medicine, Suqian, China
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Objective: The clinical treatment of complex anal fistula faces the dual challenges of cure rate and preservation of sphincter function. This study aims to evaluate the application effect of a novel surgical method - internal opening downward displacement combined with external sphincter denudation and virtual hanging drainage - in the treatment of complex anal fistula. Methods: A total of 102 patients with complex anal fistula confirmed by MRI were included in this study and randomly divided into the treatment group (internal opening downward displacement combined with external sphincter denudation and virtual hanging drainage) and the control group (traditional incision and hanging thread surgery). The surgical outcomes, changes in anal function (Wexner score), quality of life (EQ-5D score), and postoperative recurrence were compared between the two groups. The follow-up period was 12 months. Results: There were no significant differences in baseline data between the two groups. The treatment group had shorter operation time (69.22±32.81vs.77.33±40.66 minutes), shorter wound healing time (42.10±3.65vs.47.54±5.33 days), and shorter hospital stay (4.88±1.84vs.9.94±4.26 days) compared with the control group (all P<0.001); the postoperative pain score was also significantly lower (2.88±0.48 vs. 3.77±0.83, P < 0.001). One month after surgery, the number of patients who recovered in the treatment group (40 cases) was more than that in the control group (37cases, P < 0.05). The postoperative anal incontinence score in the treatment group was lower than that in the control group (1.35±0.97 vs. 4.48±1.23, P < 0.05). The complication rate in the treatment group was significantly lower than that in the control group (18.00% vs. 36.54%, P < 0.001). The recurrence rate at 1-year follow-up was only 2% in the treatment group and 7.69% in the control group (P < 0.05). The quality of life scores improved in both groups after surgery, but the improvement was more significant in the treatment group. Conclusions: The internal opening downward displacement combined with external sphincter denudation and virtual hanging drainage method shows good short-term and long-term efficacy in the treatment of complex anal fistula, balancing cure rate, fecal control function, and quality of life, and has a promising clinical application prospect.
Keywords: Anal function, Complex anal fistula, External sphincter denudation, Internal opening downward displacement, randomized controlled trial, Virtual hanging drainage
Received: 16 Oct 2025; Accepted: 02 Feb 2026.
Copyright: © 2026 Wang, Zhang, Liu, Jin, Wang and Zhao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xiu Wang
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