title: PERFACT procedure to treat supralevator fistula-in-ano: A novel single stage sphincter sparing procedure.
abstract: OBJECTIVE
  To prospectively perform the PERFACT procedure in supralevator anal fistula/abscess.
  
  
  METHODS
  Magnetic resonance imaging was done preoperatively in all the patients. Proximal cauterization around the internal opening, emptying regularly of fistula tracts and curettage of tracts (PERFACT) was done in all patients with supralevator fistula or abscess. All types of anal fistula and/or abscess with supralevator extension, whether intersphincteric or transsphincteric, were included in the study. The internal opening along with the adjacent mucosa was electrocauterized. The resulting wound was left open to heal by secondary intention so as to heal (close) the internal opening by granulation tissue. The supralevator tract/abscess was drained and thoroughly curetted. It was regularly cleaned and kept empty in the postoperative period. The primary outcome parameter was complete fistula healing. The secondary outcome parameters were return to work and change in incontinence scores (Vaizey objective scoring system) assessed preoperatively and at 3 mo after surgery.
  
  
  RESULTS
  Seventeen patients were prospectively enrolled and followed for a median of 13 mo (range 5-21 mo). Mean age was 41.1 ± 13.4 years, M:F - 15:2. Fourteen (82.4%) had a recurrent fistula, 8 (47.1%) had an associated abscess, 14 (82.4%) had multiple tracts and 5 (29.4%) had horseshoe fistulae. Infralevator part of fistula was intersphincteric in 4 and transsphincteric in 13 patients. Two patients were excluded. Eleven out of fifteen (73.3%) were cured and 26.7% (4/15) had a recurrence. Two patients with recurrence were reoperated on with the same procedure and one was cured. Thus, the overall healing rate was 80% (12/15). All the patients could resume normal work within 48 h of surgery. There was no deterioration in incontinence scores (Vaizey objective scoring system). This is the largest series of supralevator fistula-in-ano (SLF) published to date.
  
  
  CONCLUSIONS
  PERFACT procedure is an effective single step sphincter saving procedure to treat SLF with minimal risk of incontinence.
authors.affiliation: Pankaj Garg, Colorectal Surgery Division, Indus Super Specialty Hospital, Mohali, Punjab 160055, India.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Garg
keywords: Abscess; Anal fistula; Complex; Horseshoe; Simple; Supralevator; Tracts