Research Article 
Imad Diame Dhahir Al-Hasani¹*, Sahar Swadi Raheem
Abstract
The aim of this study is to present a new technique in surgical management, we called it MELT
(multiple encircling ligatures around intersphincteric tract of fistula). The study was done
between April 2012 to April 2015 and includes all patients with complex high transphincteric
and recurrent fistulas. Study includes all age groups and both genders. Operative details are
recorded and compared with other well-known procedures. Post-operative outcomes were
analyzed. Out of 56 cases, 41 were males (69%) and 17 were females (31%), with mean age
group of 38 years. 10 (18%) cases are recurrent complex fistulas and the rest are high
transphincteric type around anorectal ring. Recurrence recorded in 5 cases (9%), mild
incontinence reported in 6 cases (11%), no major incontinence occurred, 2 cases of mild
bleeding and two cases of post-operative urine retention during 18 months of post-operative
follow up. We concluded that our technical easier with relatively lower complication rates in
comparison with other well-known surgical operations for fistula-in-ano.
Key words: Complex; Transphincteric; Fistula-in-ano; MELT