The Bared External Anal Sphincter (BEAS), a New Technique for High Horseshoe Anal Fistula: a Hospital-based Cohort Study

Background: The aim of this study was to introduce a new technique, the bared external anal sphincter technique, and to evaluate its effectiveness and safety for primary or recurrent high horseshoe anal fistula (HHAF). Methods We used data from a tertiary referral hospital’s prospective database of a hospital-based cohort. All the patients underwent the bared external anal sphincter procedure. The main outcomes were the 6-month cure rate, Visual Analog Scale pain score (VAS-PS) and Cleveland Clinic Florida incontinence score (CCF-IS). The secondary outcomes included the Quality of Life in Patients with Anal Fistula Questionnaire score (QoLAF-QS), Bristol stool chart and postoperative complications. Results A total of 48 HHAF patients (39 males) with a mean age of 34.20 years (SD 9.04; range, 21-54) were analyzed in this prospective study. At the 6-month follow-up, the average VAS-PS and CCF-IS were 0.81 (SD 2.28; range, 0-10) and 1.29 (SD 2.87; range, 0-13), respectively. Three patients (6.25%) experienced recurrent symptoms but recovered after surgical management. Urinary retention occurred in 1 case (2.78%). No other postoperative complications were reported. No patient had anal incontinence. Conclusion The bared external anal sphincter procedure is a safe, effective and sphinctersparing modality for patients with primary or recurrent HHAF. Ethics and dissemination Ethical approval was obtained from the ethics committee of Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine (Approval No. 2020-823-30-01). Written informed consent was obtained from each participant.