Sphincter-sparing procedures are recommended in complex fistula to limit the risk of fecal incontinence and can be perform in all type of anal fistula. Little is known about the outcomes of a second try of sphincter sparing procedures in the situation of recurrence. The aim of this study was to report and compare the success rate of sphincter sparing anal fistula repair at the first and second attempt and to find risk factors of failure.

Patients who underwent a sphincter-sparing anal fistula repair from January 2014 to July 2021 were included in this retrospective, single-centre study. Patients with cryptogandular fistula of Crohn's disease fistula were included if it was the first or second attempt (redo) of fistula closure. Two groups of patients were defined: patients who had a first attempt of fistula closure (FA group) and patients who had a second attempt of fistula closure (SA group). The primary endpoint was the rate of fistula healing after a sphincter-sparing procedure.

72 patients fulfilled the inclusion criteria. Among them, 45 patients (62.5 %) were in the FA group and 27 (37.5 %) were in the SA group. At one month, the success rate was 86.7 % in the FA group and 81.5 % in the SA group (p = 0.7). The overall success rate was 66.7 % (n = 30) in the FA group and 44.4 % (n = 12) in the SA group (p = 0.08).

Patients who had a second attempt of sphincter-sparing anal fistula repair had similar outcomes to the one who had a first attempt.