Modified anal fistula clip: A safe and effective alternative to incision and thread hanging for anal fistula

doi:10.4240/wjgs.v18.i7.120621

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Publication Name

World Journal of Gastrointestinal Surgery

ISSN

1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Randomized Controlled Trial

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Surg. Jul 27, 2026; 18(7): 120621
Published online Jul 27, 2026. doi: 10.4240/wjgs.v18.i7.120621

Modified anal fistula clip: A safe and effective alternative to incision and thread hanging for anal fistula

Ying Han, Xiao-Li Fang, Kun Tang, Ran Tang, Xian-Shui Mei, Run Zhang, Li Chen, Jian-Min Wang, Ming Li

Ying Han, Xiao-Li Fang, Kun Tang, Ran Tang, Xian-Shui Mei, Run Zhang, Li Chen, Jian-Min Wang, Ming Li, Department of Anorectal Surgery, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei 230031, Anhui Province, China

Ming Li, Department of Anorectal, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine Anhui Hospital, Hefei 230031, Anhui Province, China

Co-corresponding authors: Jian-Min Wang and Ming Li.

Author contributions: Han Y, Wang JM, and Li M designed the study; Han Y and Fang XL wrote the manuscript and prepared figures and tables; Tang K, Tang R, and Zhang R drafted the manuscript and critically revised it for important intellectual content; Mei XS and Chen L made substantial contributions to data acquisition, analysis, and interpretation; Wang JM and Li M contributed equally to this manuscript as co-corresponding authors. All authors reviewed the manuscript.

Supported by Natural Science Foundation of Anhui Province, No. 2408085MH227; Chinese Medicine Advantageous Specialty Project of Anhui Province; Clinical Medical Research Transformation Project of Anhui Province, No. 202427b10020014; and Clinical Research Foundation of Anhui University of Chinese Medicine, No. 2020yfyzc42.

Institutional review board statement: This study was reviewed and approved by the Medical Ethics Committee of the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine (approval No. 2018AH-25).

Clinical trial registration statement: This study was not registered in a clinical trial registry. Ethical approval was obtained from the Institutional Review Board, and all participants provided written informed consent.

Informed consent statement: All study participants or their legal guardians provided written informed consent before study enrollment.

Conflict-of-interest statement: The authors report no relevant conflicts of interest for this article.

CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.

Data sharing statement: The raw data supporting the conclusions of this article will be made available by the authors without undue reservation.

Corresponding author: Ming Li, MD, Department of Anorectal Surgery, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, No. 116 Meishan Street, Hefei 230031, Anhui Province, China. lmyys154@163.com

Received: March 6, 2026
Revised: April 1, 2026
Accepted: April 8, 2026
Published online: July 27, 2026
Processing time: 143 Days and 2.3 Hours

Abstract

BACKGROUND

Anal fistula is a common anorectal disorder, for which incision and thread hanging (ITH) remains a widely used treatment. However, ITH is often associated with substantial postoperative discomfort and carries a risk of anal sphincter injury, potentially compromising functional outcomes. The anal fistula clip (AFC) is a novel surgical technique designed to occlude the internal orifice of the fistula, eliminate infection source, and preserve anal sphincter function.

AIM

To compare the efficacy and safety between AFC and ITH in a randomized, single-center study focusing on short-term postoperative outcomes.

METHODS

A total of 70 patients with anal fistula who underwent surgery from August 2019 to January 2025 were randomly assigned to the ITH or AFC group. The primary outcomes included cure rates, pain scores, anal sphincter function, and complications. Patients were followed up postoperatively for 6 months.

RESULTS

All surgeries were successfully performed, with postoperative cure rates exceeding 90% in both groups. No severe complications or postoperative fecal incontinence occurred. Compared with the ITH group, the AFC group demonstrated better outcomes in early postoperative pain (P < 0.01), wound healing time (P < 0.01), and anal sphincter function preservation (P < 0.05).

CONCLUSION

Compared with ITH, AFC may reduce postoperative pain, shorten healing time, preserve function, and minimize complications. AFC may be safe and effective; however, larger studies with longer follow-up are needed.

Keywords: Anal fistula clip; Incision and thread hanging treatment; Anal fistula; Anal sphincter function; Postoperative pain; Complications

Core Tip: This exploratory study compared the anal fistula clip (AFC) with conventional incision and thread hanging in 70 patients with anal fistulas. Both techniques achieved high short-term cure rates, with AFC demonstrating early postoperative pain reduction, faster wound healing, and better sphincter function preservation. No recurrences were observed during the follow-up period, although these findings were preliminary. By directly closing the internal orifice through sustained centripetal compression, the AFC interrupts infection source while minimizing sphincter injury. Therefore, AFC may be a safe, minimally invasive, and function-preserving alternative for anal fistula management, warranting further investigation in larger and long-term studies.