Introduction
trans-sphincteric anal fistula, perianal fistula, inter-sphincteric fistula, fistula
ANORECTAL FISTULA, RECURRENCE, INCONTINENCE
Anorectal fistulas are characterized by their tract location relative to the internal and external sphincters so a trans-sphincteric fistula is one that crosses to the other side of the external sphincter before exiting in the perianal area and thus involving both sphincters, Trans-sphincteric fistulas represent a challenge in management because of this and often require more complex or staged treatment [High ligation of the inter-sphincteric fistula track by lateral approach is a new sphincter preserving technique for the treatment of anal fistula which was introduced by Chen et al. in 2012 to overcome disadvantages of the traditional LIFT technique [However, Conventional fistulotomy is a commonly used procedure and is still relied on by the majority of surgeons as the gold standard for the treatment of perianal fistula, so compared to other treatment modalities for complex trans-sphincteric anal fistula found in literature, it had been found that one stage surgery, which is Fistulotomy and primary sphincteroplasty has good results regarding healing of the fistula with acceptable risk of incontinence, relatively less recurrence rate and good wound healing [