Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May 16:12:1589278.
doi: 10.3389/fmed.2025.1589278. eCollection 2025.

Evaluation of the RIFER procedure in treating high intersphincteric anal fistulas

Yan Ding  1 , Yahong Xue  1 , Yaqiu Miao  1 , Huiting Zhu  1 , Rui Ye  2 , Xiaofeng Wang  1
Affiliations

Evaluation of the RIFER procedure in treating high intersphincteric anal fistulas

Yan Ding et al. Front Med (Lausanne). .

Abstract

Introduction: A high intersphincteric anal fistula is a common anorectal disease that is challenging to treat due to high recurrence rates and has the risk of sphincter damage, which can lead to incontinence. This study aimed to evaluate the efficacy and safety of the rectal incision, fistula excision, and reconstruction (RIFER) procedure for treating high intersphincteric anal fistulas.

Methods: Twenty-six patients with high intersphincteric anal fistulas who were admitted to Nanjing Hospital of Traditional Chinese Medicine between September 2021 and March 2024 and underwent the RIFER procedure were included. Patients were followed up for 6 months, and treatment efficacy, recurrence, and postoperative complications after the RIFER procedure were assessed.

Results: The surgical cure rate of patients treated with RIFER was 100%, with no recurrence or postoperative complications during the follow-up period. The average wound-healing time was 45.40 days. Functional scoring indicators, such as the visual analog and Wexner anal function scores, improved at different postoperative time points. After the RIFER procedure, the incision scar score of most patients (18 of 25) was 0, and none of the patients reported keyhole-like anal deformities. The mean hospital stay was 10.15 days.

Conclusion: The RIFER procedure demonstrated remarkable efficacy and safety in the treatment of high intersphincteric anal fistulas, with no recurrence or postoperative complications. This procedure is suitable for treating high intersphincteric anal fistulas in clinical practice.

Keywords: RIFER; complications; functional outcome; high intersphincteric anal fistula; retrospective study.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

    1. Yamana T. Japanese practice guidelines for anal disorders II. Anal fistula. J Anus Rectum Colon. (2018) 2:103–9. doi: 10.23922/jarc.2018-009, PMID: - DOI - PMC - PubMed
    1. Van Praag EM, Stellingwerf ME, van der Bilt JDW, Bemelman WA, Gecse KB, Buskens CJ. Ligation of the intersphincteric fistula tract and Endorectal advancement flap for high perianal fistulas in Crohn's disease: a retrospective cohort study. J Crohns Colitis. (2020) 14:757–63. doi: 10.1093/ecco-jcc/jjz181, PMID: - DOI - PMC - PubMed
    1. Fox A, Tietze PH, Ramakrishnan K. Anorectal conditions: anal fissure and anorectal fistula. FP Essent. (2014) 419:20–7. PMID: - PubMed
    1. Hermann J, Eder P, Banasiewicz T, Matysiak K, Łykowska-Szuber L. Current management of anal fistulas in Crohn's disease. Prz Gastroenterol. (2015) 2:83–8. doi: 10.5114/pg.2015.49684, PMID: - DOI - PMC - PubMed
    1. Nottingham JM, Rentea RM. Anal fistulotomy In:. StatPearls. Treasure Island, FL: StatPearls Publishing; (2023) - PubMed

LinkOut - more resources