A Novel Technique for Complex Rectal Fistula Closure With Ligasure: Efficacy and Functional Outcomes

The management of complex rectal fistulas remains one of the most challenging tasks in modern coloproctology. High transsphincteric and extrasphincteric fistulas, recurrent or multi-tract variants, are characterized by complex anatomy, difficulty of radical excision, and a high risk of sphincter damage, often resulting in postoperative fecal incontinence. Traditional surgical techniques, including cutting seton and advancement flap, show limited efficacy in preserving sphincter function and are associated with high recurrence rates (up to 20%) and the risk of incontinence (up to 10–15%). This highlights the urgent need for minimally invasive, sphincter-sparing approaches that can provide radical cure with minimal trauma.