Kenneth KT VOON 1, A Shanwani M SIDEK2, KM MAZLAN3, Zaidi ZAKARIA4

 1Department of Surgery, Hospital Raja Perempuan Zainab II, Kota Bharu, Malaysia / Hospital Selayang, Selangor, Malaysia.

2 Department of Surgery, Hospital Raja Perempuan Zainab II, Kota Bharu, Malaysia

3 Department of Surgery, Hospital Universiti Sains Malaysia, Kubang Kerian, Malaysia

4 Hospital Perdana KPJ, Kota Bharu, Malaysia



Introduction: Surgical management of transphincteric fistula-in-ano remains a challenge despite various surgical techniques and novel procedures. We report the results of a staged surgical approach named Modified 2 Staged Fistulectomy with Sphincter Repair (m2FiSR) Procedure in our centre. Methodology: Retrospective review of medical records was done for patients with transphincteric fistula-in-ano who underwent elective surgery from 1 January 2015 31 December 2019 (5 years) under Colorectal Unit in our centre. All patients included had undergone the m2FiSR. First stage was examination under anaesthesia and draining seton insertion, followed by second stage Fistulectomy with Sphincter Repair 6 months later under spinal anaesthesia. Data were collected from elective surgery operating notes and clinic records of follow-up at 6 weeks and 1 year post operatively. Outcomes: Primary outcome: recurrence rate at 1 year; Secondary outcome: wound infection rate at 6 weeks and incontinence rate at 1 year. Results: 44 patients were included. Mean age in this study population was 39.3 year. 82% were male and 18% were female. Recurrence rate was 9%. Wound infection rate was 9%. At 1 year, 93% had incontinence score of 0, 7% had incontinence score between 1-5. None scored more than 3. We observed 57% of high transphincteric fistula were reclassified to low transphincteric fistula after 6 months on draining seton. Conclusion: m2FiSR approach with initial draining seton followed by fistulectomy with sphincter repair is a safe and effective option for transphincteric fistula-in-ano.


Keywords: Anal sphincter, Fecal incontinence, Fistula-in-ano, Recurrence, Surgical procedure.


Corresponding author: Dr Kenneth Voon Kher Ti, MMED(Surgery), Department of Surgery Hospital Raja Perempuan Zainab II, Kota Bharu, Malaysia. Phone: +60128803555; Email:


 Brunei Int Med J. 2020;16:117-123