Materiały źródłowe

• #1 Anal Fistula: What It Is, Symptoms, Treatment & Surgery

  https://my.clevelandclinic.org/health/diseases/14466-anal-fistula

  An anal fistula is usually a side effect of an anal abscess, an infected wound that drains pus from your anus. Surgery is the primary treatment. […] Most anal fistulas will require surgery to fix. Spontaneous healing is usually followed by recurring infections and abscesses that reopen the fistula. However, if your fistula is caused by inflammatory bowel disease and isn’t infected, it’ll occasionally heal with medical treatment. Your provider might try treatment with an immunomodulator, like infliximab, before resorting to surgery for these fistulas. […] Anal fistula surgery can be simple or complex, depending on how simple or complex the fistula is. The most common anal fistulas are simple, intersphincteric fistulas, which only involve a small amount of muscle. These are safe to treat in a single operation. More complex fistulas may need surgery in stages.

• #1 Anal fistula – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anal-fistula/diagnosis-treatment/drc-20537243

  To diagnose an anal fistula, your health care provider will discuss your symptoms and do a physical exam. The goals are to repair the anal fistula completely to prevent recurrence and to protect the sphincter muscles. Although surgery is usually required, sometimes nonsurgical treatments may be an option. Surgical options include: Fistulotomy. The surgeon cuts the fistula’s internal opening, scrapes and flushes out the infected tissue, and then flattens the tunnel and stitches it in place. Nonsurgical options include: Seton placement. The surgeon places a seton into the fistula to help drain the infection. This allows the tunnel to heal. In cases of complex anal fistula, more-invasive surgical procedures may be recommended, including: Ostomy and stoma. The surgeon creates a temporary opening in the abdomen to divert the intestines away from the anal canal. This procedure allows the anal area time to heal. […] Treatment of an anal fistula depends on the fistula’s location and complexity and its cause.

• #2 Recent advances in the diagnosis and treatment of complex anal fistula

  https://www.coloproctol.org/journal/view.php?number=2057

  Anal fistula can be a challenging condition to manage, with complex fistulas presenting even greater difficulties. The primary concerns in treating this condition are a risk of damage to the anal sphincters, which can compromise fecal continence, and refractoriness to treatment, as evidenced by a high recurrence rate. Furthermore, the treatment of complex anal fistula involves several additional challenges. Satisfactory solutions to many of these obstacles remain elusive, and no consensus has been established regarding the available treatment options. In summary, complex anal fistula has no established gold-standard treatment, and the quest for effective therapies continues. This review discusses and highlights groundbreaking advances in the management of complex anal fistula over the past decade.

• #2 Management of Complex Anal Fistulas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4755767/

  Complex anal fistulas require careful evaluation. Prior to any attempts at definitive repair, the anatomy must be well defined and the sepsis resolved. Several muscle-sparing approaches to anal fistula are appropriate, and are often catered to the patient based on their presentation and previous repairs. Emerging technologies show promise for fistula repair, but lack long-term data. […] The initial management strategy prior to any definitive treatment is to have local control of perianal sepsis, particularly if an abscess exists. This may include draining an abscess cavity or placing a draining seton into the fistula to allow the area to cool off. Definitive repair in the setting of active infection often leads to lower healing rates. […] Definitive management requires addressing the underlying fistula tract itself. Options include setons (temporary draining, cutting), fistulotomy or fistulectomy (primary or staged, with or without sphincteroplasty), endorectal advancement flap, anocutaneous advancement flap, fistula plug, fibrin glue, electrocauterization of tract/laser (fistula laser closure [FiLaC]), and ligation of intersphincteric fistula tract (LIFT). Each of these will be discussed individually in the text that follows.

• #3 Recent advances in the diagnosis and treatment of complex anal fistula

  https://coloproctol.org/journal/view.php?doi=10.3393/ac.2024.00325.0046

  Anal fistula can be a challenging condition to manage, with complex fistulas presenting even greater difficulties. The primary concerns in treating this condition are a risk of damage to the anal sphincters, which can compromise fecal continence, and refractoriness to treatment, as evidenced by a high recurrence rate. Furthermore, the treatment of complex anal fistula involves several additional challenges. Satisfactory solutions to many of these obstacles remain elusive, and no consensus has been established regarding the available treatment options. In summary, complex anal fistula has no established gold-standard treatment, and the quest for effective therapies continues. This review discusses and highlights groundbreaking advances in the management of complex anal fistula over the past decade.

• #3 Management of Complex Anal Fistulas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4755767/

  Complex anal fistulas require careful evaluation. Prior to any attempts at definitive repair, the anatomy must be well defined and the sepsis resolved. Several muscle-sparing approaches to anal fistula are appropriate, and are often catered to the patient based on their presentation and previous repairs. Emerging technologies show promise for fistula repair, but lack long-term data. […] The initial management strategy prior to any definitive treatment is to have local control of perianal sepsis, particularly if an abscess exists. This may include draining an abscess cavity or placing a draining seton into the fistula to allow the area to cool off. Definitive repair in the setting of active infection often leads to lower healing rates. […] Definitive management requires addressing the underlying fistula tract itself. Options include setons (temporary draining, cutting), fistulotomy or fistulectomy (primary or staged, with or without sphincteroplasty), endorectal advancement flap, anocutaneous advancement flap, fistula plug, fibrin glue, electrocauterization of tract/laser (fistula laser closure [FiLaC]), and ligation of intersphincteric fistula tract (LIFT). Each of these will be discussed individually in the text that follows.

• #4 Anal Fistula: What It Is, Symptoms, Treatment & Surgery

  https://my.clevelandclinic.org/health/diseases/14466-anal-fistula

  An anal fistula is usually a side effect of an anal abscess, an infected wound that drains pus from your anus. Surgery is the primary treatment. […] Most anal fistulas will require surgery to fix. Spontaneous healing is usually followed by recurring infections and abscesses that reopen the fistula. However, if your fistula is caused by inflammatory bowel disease and isn’t infected, it’ll occasionally heal with medical treatment. Your provider might try treatment with an immunomodulator, like infliximab, before resorting to surgery for these fistulas. […] Anal fistula surgery can be simple or complex, depending on how simple or complex the fistula is. The most common anal fistulas are simple, intersphincteric fistulas, which only involve a small amount of muscle. These are safe to treat in a single operation. More complex fistulas may need surgery in stages.

• #5 Anal Fistula Treatment – IFFGD

  https://iffgd.org/gi-disorders/other-disorders/anal-fistulas/anal-fistula-treatment/

  There is one medication that can be used to treat Crohns complex perianal fistulas (CPF). It is in a class called Biologic Therapies. These medications are antibodies created in a laboratory made from materials found in life, not a chemical compound used in pharmacology. Biologics stop certain proteins in the body from causing inflammation. […] Infliximab (Remicade) is an intravenous infusion that has been approved by the FDA for the treatment and maintenance of remission of Crohns disease and ulcerative colitis. It is also approved for reducing the number of draining fistulas and maintaining fistula closure in adult patients with fistulizing disease.

• #6 Anal Fistulas and Fissures Medication: Laxatives, Bulk-Producing, Vasodilators, Anxiolytics, Benzodiazepines, Antibiotics, Calcium Channel Blockers, Neuromuscular Blockers, Botulinum Toxins

  https://emedicine.medscape.com/article/776150-medication

  Medications may also be prescribed for anal fissures, such as topical nitrates, calcium channel blockers, and onabotulinumtoxinA injections, and are considered first-line therapy. These medications reduce anal sphincter tone, which, in turn, increases anodermal blood flow. […] Antibiotics may be necessary for the treatment of anal fistulas, especially if the patient presents with systemic symptoms. Postoperative prophylactic antibiotic therapy for 7-10 days (eg, ciprofloxacin, metronidazole) appears to be a key part of preventing anal fistulas after incision and drainage of perianal abscess. […] OnabotulinumtoxinA has been shown to be as effective as topical nitrates, but with fewer adverse effects, including headache, and can be an alternative to surgery. […] Sphincter-preserving fistulectomy is an effective minimally invasive technique for complex anal fistulas. […] Antibiotic therapy for prevention of fistula in-ano after incision and drainage of simple perianal abscess: A randomized single blind clinical trial.

• #7 Anal Fistula

  https://austinregionalclinic.staywellsolutionsonline.com/Search/134,173

  Once you have an anal fistula, antibiotics alone won’t get rid of it. You’ll need to have surgery to treat the fistula. Surgical treatment includes: […] Anal fistulas are very common in people with Crohns disease. For those with both Crohn’s disease and a fistula, medical therapy is often tried before surgery. […] Antibiotics alone won’t fix it. You will need to have surgery to cure the fistula.

• #8 Anal Fistula: What It Is, Symptoms, Treatment & Surgery

  https://my.clevelandclinic.org/health/diseases/14466-anal-fistula

  An anal fistula is usually a side effect of an anal abscess, an infected wound that drains pus from your anus. Surgery is the primary treatment. […] Most anal fistulas will require surgery to fix. Spontaneous healing is usually followed by recurring infections and abscesses that reopen the fistula. However, if your fistula is caused by inflammatory bowel disease and isn’t infected, it’ll occasionally heal with medical treatment. Your provider might try treatment with an immunomodulator, like infliximab, before resorting to surgery for these fistulas. […] Anal fistula surgery can be simple or complex, depending on how simple or complex the fistula is. The most common anal fistulas are simple, intersphincteric fistulas, which only involve a small amount of muscle. These are safe to treat in a single operation. More complex fistulas may need surgery in stages.

• #9 Anal Fistula Treatment – IFFGD

  https://iffgd.org/gi-disorders/other-disorders/anal-fistulas/anal-fistula-treatment/

  There is one medication that can be used to treat Crohns complex perianal fistulas (CPF). It is in a class called Biologic Therapies. These medications are antibodies created in a laboratory made from materials found in life, not a chemical compound used in pharmacology. Biologics stop certain proteins in the body from causing inflammation. […] Infliximab (Remicade) is an intravenous infusion that has been approved by the FDA for the treatment and maintenance of remission of Crohns disease and ulcerative colitis. It is also approved for reducing the number of draining fistulas and maintaining fistula closure in adult patients with fistulizing disease.

• #10 Fistula-in-Ano Treatment & Management: Approach Considerations, Fistulotomy, Seton Placement

  https://emedicine.medscape.com/article/190234-treatment

  Therapeutic intervention is indicated for symptomatic patients. Symptoms usually involve recurrent episodes of anorectal sepsis. An abscess develops easily if the external opening on the perianal skin seals itself. […] Surgery for fistula-in-ano should not be performed for definitive repair of the fistula in the setting of anorectal abscess (unless the fistula is superficial and the tract is obvious). In the acute phase, simple incision and drainage of the abscess are sufficient. […] Studies have identified a role in Crohn disease for fistula therapy with infliximab, with 50-60% response rates for perianal fistulas. […] Adipose-derived stem-cell therapy is being studied for use in the treatment of Crohn fistula and other complex fistulas. […] A seton can be placed alone, in combination with fistulotomy, or in a staged fashion. This technique is useful in patients with complex fistulas (ie, high transsphincteric, suprasphincteric, extrasphincteric) or multiple fistulas.

• #11 Anal Fistula: What It Is, Symptoms, Treatment & Surgery

  https://my.clevelandclinic.org/health/diseases/14466-anal-fistula

  An anal fistula is usually a side effect of an anal abscess, an infected wound that drains pus from your anus. Surgery is the primary treatment. […] Most anal fistulas will require surgery to fix. Spontaneous healing is usually followed by recurring infections and abscesses that reopen the fistula. However, if your fistula is caused by inflammatory bowel disease and isn’t infected, it’ll occasionally heal with medical treatment. Your provider might try treatment with an immunomodulator, like infliximab, before resorting to surgery for these fistulas. […] Anal fistula surgery can be simple or complex, depending on how simple or complex the fistula is. The most common anal fistulas are simple, intersphincteric fistulas, which only involve a small amount of muscle. These are safe to treat in a single operation. More complex fistulas may need surgery in stages.

• #12 Anal fistula – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anal-fistula/diagnosis-treatment/drc-20537243

  To diagnose an anal fistula, your health care provider will discuss your symptoms and do a physical exam. The goals are to repair the anal fistula completely to prevent recurrence and to protect the sphincter muscles. Although surgery is usually required, sometimes nonsurgical treatments may be an option. Surgical options include: Fistulotomy. The surgeon cuts the fistula’s internal opening, scrapes and flushes out the infected tissue, and then flattens the tunnel and stitches it in place. Nonsurgical options include: Seton placement. The surgeon places a seton into the fistula to help drain the infection. This allows the tunnel to heal. In cases of complex anal fistula, more-invasive surgical procedures may be recommended, including: Ostomy and stoma. The surgeon creates a temporary opening in the abdomen to divert the intestines away from the anal canal. This procedure allows the anal area time to heal. […] Treatment of an anal fistula depends on the fistula’s location and complexity and its cause.

• #13 Management of Complex Anal Fistulas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4755767/

  Draining setons are an effective way to control perianal sepsis. They can serve to prevent blockage of the fistula tract and allow it to mature, and may be particularly useful if a complex repair is planned in the future. […] Cutting setons have been used for many years to manage complex fistula-in-ano. In this procedure, the seton is secured tightly within the fistula tract, with intentional pressure placed on the tract itself. […] Primary fistulotomy has been the mainstay of treatment for the simple anal fistula, and remains extremely useful for intersphincteric and low transsphincteric fistulas. Higher fistulas are potentially a much different problem, though good evidence is lacking. […] The endorectal advancement flap involves mobilizing a partial-thickness flap comprising rectal mucosa, submucosa, and some muscle fibers.

• #14 Anal Fistula: What It Is, Symptoms, Treatment & Surgery

  https://my.clevelandclinic.org/health/diseases/14466-anal-fistula

  If your anal fistula involves only a minimal amount of muscle and doesn’t have any branches, it’s considered a simple fistula. The surgical treatment for a simple fistula is called a fistulotomy. This one-and-done procedure is the easiest and the most effective way to treat an anal fistula (about 95%). […] Your fistula is considered complex if it involves a significant amount of muscle, if it has branches or if you have preexisting conditions that raise your risk of complications from surgery. Complex fistulas may require multiple surgeries to fix. […] The main risks are: Recurring infection. If the infection isn’t completely gone from your fistula, it may continue inside your healing fistula. […] Anal fistula procedures are generally outpatient procedures, so you can go home the same day, although some people will need to return for more surgery later. You’ll have prescription pain medication to take home with you, along with some instructions for self-care.

• #15 Recent advances in the diagnosis and treatment of complex anal fistula

  https://coloproctol.org/journal/view.php?doi=10.3393/ac.2024.00325.0046

  The aim of the surgical treatment of anal fistula is to achieve definitive healing through closure, obliteration, or excision of the fistula tract while avoiding fecal incontinence (FI). […] Fistulotomy remains the gold standard for treating low fistulas. However, this procedure is highly underutilized due to concerns about incontinence. This underutilization is regrettable, considering that fistulotomy is associated with the highest success rates, ranging from 95% to 100%. […] The Garg classification effectively addresses this concern. Additionally, fistulotomy is a technically straightforward procedure and is widely performed by general surgeons around the world, especially in developing countries. […] Fistulotomy has the highest cure rate among all known procedures, with an impressive 96% to 99% success rate. However, it remains highly underutilized due to surgeons’ concerns about incontinence.

• #16 Recent advances in the diagnosis and treatment of complex anal fistula

  https://www.coloproctol.org/journal/view.php?number=2057

  The aim of the surgical treatment of anal fistula is to achieve definitive healing through closure, obliteration, or excision of the fistula tract while avoiding fecal incontinence (FI). […] Fistulotomy remains the gold standard for treating low fistulas. However, this procedure is highly underutilized due to concerns about incontinence. This underutilization is regrettable, considering that fistulotomy is associated with the highest success rates, ranging from 95% to 100%. Consequently, when low fistulas suitable for fistulotomy are subjected to alternative treatments with lower success rates, unnecessary recurrences may result. […] The Garg classification effectively addresses this concern. Additionally, fistulotomy is a technically straightforward procedure and is widely performed by general surgeons around the world, especially in developing countries.

• #17 Anal fistula – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anal-fistula/diagnosis-treatment/drc-20537243

  To diagnose an anal fistula, your health care provider will discuss your symptoms and do a physical exam. The goals are to repair the anal fistula completely to prevent recurrence and to protect the sphincter muscles. Although surgery is usually required, sometimes nonsurgical treatments may be an option. Surgical options include: Fistulotomy. The surgeon cuts the fistula’s internal opening, scrapes and flushes out the infected tissue, and then flattens the tunnel and stitches it in place. Nonsurgical options include: Seton placement. The surgeon places a seton into the fistula to help drain the infection. This allows the tunnel to heal. In cases of complex anal fistula, more-invasive surgical procedures may be recommended, including: Ostomy and stoma. The surgeon creates a temporary opening in the abdomen to divert the intestines away from the anal canal. This procedure allows the anal area time to heal. […] Treatment of an anal fistula depends on the fistula’s location and complexity and its cause.

• #18 Management of Complex Anal Fistulas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4755767/

  Draining setons are an effective way to control perianal sepsis. They can serve to prevent blockage of the fistula tract and allow it to mature, and may be particularly useful if a complex repair is planned in the future. […] Cutting setons have been used for many years to manage complex fistula-in-ano. In this procedure, the seton is secured tightly within the fistula tract, with intentional pressure placed on the tract itself. […] Primary fistulotomy has been the mainstay of treatment for the simple anal fistula, and remains extremely useful for intersphincteric and low transsphincteric fistulas. Higher fistulas are potentially a much different problem, though good evidence is lacking. […] The endorectal advancement flap involves mobilizing a partial-thickness flap comprising rectal mucosa, submucosa, and some muscle fibers.

• #19 Anal Fistula Treatment – IFFGD

  https://iffgd.org/gi-disorders/other-disorders/anal-fistulas/anal-fistula-treatment/

  Other procedures include: Fistulotomy: If the fistula is too deep for a simple drainage, the fistula track will be opened to allow healing from the bottom up. The surgeon will cut the internal opening of the fistula, clean the infected area, and then flatten the tunnel and stitch it in place. This type of surgery may require cutting into the sphincter muscle. If the fistula tunnel involves a large portion of the sphincter muscle, other surgeries may be considered in order to minimize injury to the sphincter muscle which controls continence. […] Seton drain placement. This procedure places a surgical thread into the fistula in order to keep it open and drain the discharge. The surgeon may remove the drain and close the fistula with a fistulotomy or another procedure once the fistula has healed. However, if the fistula is caused by a chronic condition, it may be left in.

• #20 Management of Complex Anal Fistulas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4755767/

  Draining setons are an effective way to control perianal sepsis. They can serve to prevent blockage of the fistula tract and allow it to mature, and may be particularly useful if a complex repair is planned in the future. […] Cutting setons have been used for many years to manage complex fistula-in-ano. In this procedure, the seton is secured tightly within the fistula tract, with intentional pressure placed on the tract itself. […] Primary fistulotomy has been the mainstay of treatment for the simple anal fistula, and remains extremely useful for intersphincteric and low transsphincteric fistulas. Higher fistulas are potentially a much different problem, though good evidence is lacking. […] The endorectal advancement flap involves mobilizing a partial-thickness flap comprising rectal mucosa, submucosa, and some muscle fibers.

• #21 Anal Fistula Treatment – IFFGD

  https://iffgd.org/gi-disorders/other-disorders/anal-fistulas/anal-fistula-treatment/

  Other procedures include: Fistulotomy: If the fistula is too deep for a simple drainage, the fistula track will be opened to allow healing from the bottom up. The surgeon will cut the internal opening of the fistula, clean the infected area, and then flatten the tunnel and stitch it in place. This type of surgery may require cutting into the sphincter muscle. If the fistula tunnel involves a large portion of the sphincter muscle, other surgeries may be considered in order to minimize injury to the sphincter muscle which controls continence. […] Seton drain placement. This procedure places a surgical thread into the fistula in order to keep it open and drain the discharge. The surgeon may remove the drain and close the fistula with a fistulotomy or another procedure once the fistula has healed. However, if the fistula is caused by a chronic condition, it may be left in.

• #22 Management of Complex Anal Fistulas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4755767/

  Draining setons are an effective way to control perianal sepsis. They can serve to prevent blockage of the fistula tract and allow it to mature, and may be particularly useful if a complex repair is planned in the future. […] Cutting setons have been used for many years to manage complex fistula-in-ano. In this procedure, the seton is secured tightly within the fistula tract, with intentional pressure placed on the tract itself. […] Primary fistulotomy has been the mainstay of treatment for the simple anal fistula, and remains extremely useful for intersphincteric and low transsphincteric fistulas. Higher fistulas are potentially a much different problem, though good evidence is lacking. […] The endorectal advancement flap involves mobilizing a partial-thickness flap comprising rectal mucosa, submucosa, and some muscle fibers.

• #23 Fistula-in-Ano Treatment & Management: Approach Considerations, Fistulotomy, Seton Placement

  https://emedicine.medscape.com/article/190234-treatment

  Therapeutic intervention is indicated for symptomatic patients. Symptoms usually involve recurrent episodes of anorectal sepsis. An abscess develops easily if the external opening on the perianal skin seals itself. […] Surgery for fistula-in-ano should not be performed for definitive repair of the fistula in the setting of anorectal abscess (unless the fistula is superficial and the tract is obvious). In the acute phase, simple incision and drainage of the abscess are sufficient. […] Studies have identified a role in Crohn disease for fistula therapy with infliximab, with 50-60% response rates for perianal fistulas. […] Adipose-derived stem-cell therapy is being studied for use in the treatment of Crohn fistula and other complex fistulas. […] A seton can be placed alone, in combination with fistulotomy, or in a staged fashion. This technique is useful in patients with complex fistulas (ie, high transsphincteric, suprasphincteric, extrasphincteric) or multiple fistulas.

• #24 Management of Complex Anal Fistulas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4755767/

  Complex anal fistulas require careful evaluation. Prior to any attempts at definitive repair, the anatomy must be well defined and the sepsis resolved. Several muscle-sparing approaches to anal fistula are appropriate, and are often catered to the patient based on their presentation and previous repairs. Emerging technologies show promise for fistula repair, but lack long-term data. […] The initial management strategy prior to any definitive treatment is to have local control of perianal sepsis, particularly if an abscess exists. This may include draining an abscess cavity or placing a draining seton into the fistula to allow the area to cool off. Definitive repair in the setting of active infection often leads to lower healing rates. […] Definitive management requires addressing the underlying fistula tract itself. Options include setons (temporary draining, cutting), fistulotomy or fistulectomy (primary or staged, with or without sphincteroplasty), endorectal advancement flap, anocutaneous advancement flap, fistula plug, fibrin glue, electrocauterization of tract/laser (fistula laser closure [FiLaC]), and ligation of intersphincteric fistula tract (LIFT). Each of these will be discussed individually in the text that follows.

• #25 Recent advances in the diagnosis and treatment of complex anal fistula

  https://www.coloproctol.org/journal/view.php?number=2057

  Fistulotomy has the highest cure rate among all known procedures, with an impressive 96% to 99% success rate. However, it remains highly underutilized due to surgeons’ concerns about incontinence. […] The TROPIS procedure, a recently developed sphincter-preserving technique, stands out as the most promising of these approaches for managing complex anal fistulas. […] The LIFT procedure has been popular for over a decade as a sphincter-sparing procedure for the treatment of complex fistula. […] The loose draining seton continues to play a role in the management of anal fistulas, serving as an adjunct to other procedures, and in the treatment of acute abscesses. However, the cutting seton also remains in use in many regions globally. […] Platelet-rich plasma (PRP) has shown positive results when used as an adjunct to other procedures. […] Stem cell therapy could represent a novel therapeutic approach for complex perianal fistulas, demonstrating high efficacy in the short term.

• #26 Management of Complex Anal Fistulas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4755767/

  The anal fistula plug (AFP) technique was first described in 2004, with the first case series published in 2006. The technique involves debridement of the fistula tract followed by placement of a bioprosthetic plug within the tract, securing it at the internal opening and cutting it flush with the skin at the external opening. […] The technique that has perhaps gained the most traction in recent years is the LIFT procedure. […] One of the newest technologies on the market is the use of a laser to ablate the fistula tract. […] Anal fistulas after ileal pouch-anal anastomosis are particularly complex, usually resulting from an anastomotic defect. […] There are multiple techniques available for the repair of complex anal fistulas. The best technique is not known, and the available evidence suffers from a lack of high-quality data, with very few large randomized studies.

• #27 Anal Fistula Treatment – IFFGD

  https://iffgd.org/gi-disorders/other-disorders/anal-fistulas/anal-fistula-treatment/

  Ligation of the intersphincteric fistula tract (LIFT). This procedure is designed to avoid cutting the sphincter muscle entirely by accessing the fistula between the sphincter muscles and avoid cutting them. This procedure usually follows a seton drain procedure described above. With this procedure, after the seton drain is removed, the surgeon closes, likely with stiches, the part of the fistula between the sphincter muscles. […] Endorectal advancement flap: This procedure is used to reduce the amount of sphincter muscle that is cut by the surgery. In this procedure, the infected tissue around the inside opening of the fistula is removed. A healthy piece of tissue (flap) from the inside of your rectum is cut and the opening of the fistula is covered with it. The fistula should continue to drain and heal from the inside out.

• #28 Recent advances in the diagnosis and treatment of complex anal fistula

  https://coloproctol.org/journal/view.php?doi=10.3393/ac.2024.00325.0046

  The TROPIS procedure, a recently developed sphincter-preserving technique, stands out as the most promising of these approaches for managing complex anal fistulas. […] The LIFT procedure has been popular for over a decade as a sphincter-sparing procedure for the treatment of complex fistula. […] These device-based procedures primarily aim to manage the external aspects of fistula tracts without addressing the intersphincteric portion. Consequently, these procedures tend to have moderate success in treating simple low fistulas, which typically have minimal or no intersphincteric involvement, while they exhibit a lower success rate in managing complex high fistulas, which typically include a segment of the fistula tract within the intersphincteric plane. […] Platelet-rich plasma (PRP) has shown positive results when used as an adjunct to other procedures. […] Stem cell therapy could represent a novel therapeutic approach for complex perianal fistulas, demonstrating high efficacy in the short term.

• #29 Anal Fistula Treatment – IFFGD

  https://iffgd.org/gi-disorders/other-disorders/anal-fistulas/anal-fistula-treatment/

  Ligation of the intersphincteric fistula tract (LIFT). This procedure is designed to avoid cutting the sphincter muscle entirely by accessing the fistula between the sphincter muscles and avoid cutting them. This procedure usually follows a seton drain procedure described above. With this procedure, after the seton drain is removed, the surgeon closes, likely with stiches, the part of the fistula between the sphincter muscles. […] Endorectal advancement flap: This procedure is used to reduce the amount of sphincter muscle that is cut by the surgery. In this procedure, the infected tissue around the inside opening of the fistula is removed. A healthy piece of tissue (flap) from the inside of your rectum is cut and the opening of the fistula is covered with it. The fistula should continue to drain and heal from the inside out.

• #30 Anal fistula – Care at Mayo Clinic – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anal-fistula/care-at-mayo-clinic/mac-20352874

  Mayo Clinic specialists can offer a range of treatment options depending on the fistula’s location, complexity and cause. The goals are to repair the anal fistula completely to prevent recurrence and to protect the sphincter muscles. LIFT is a two-stage treatment performed at Mayo Clinic for more-complex or deep fistulas. […] Mayo Clinic specialists offer the latest treatment therapies to help eliminate anal fistulas while preserving healthy tissue and function. Treatment options include seton placement and fibrin glue. Surgical options include standard fistulotomy, as well as ligation of the intersphincteric fistula tract (LIFT) for complex anal fistulas.

• #31 Anal Fistula – Symptoms, Diagnosis and Treatment

  https://www.samitivejhospitals.com/page/Anal-fistula-diagnosis-treatment-South-Asia

  In the case of deep or multi-tract fistulas, the fistula tract cannot be removed entirely, as this would require too much of the sphincter muscle to be excised resulting in fecal incontinence. […] LIFT (Ligation of Intersphincteric Fistula Tract) is an operation to close off the internal opening of the fistula in order to prevent bacteria inside the anus from entering the cavity. […] Seton Placement involves the placement of a silk or latex string (seton) into the fistula to help drain the infection. […] Advancement Rectal Flap involves taking mucosal tissue from the lining of the rectal wall before removing the fistula’s internal opening. […] Laser treatment involves the insertion of a laser probe into the external opening of the fistula in order to close up the entire tract(s). […] A key priority for doctors will be to avoid fecal incontinence caused by the removal of too much of the sphincter muscles or cutting into them.

• #32 Management of Complex Anal Fistulas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4755767/

  Draining setons are an effective way to control perianal sepsis. They can serve to prevent blockage of the fistula tract and allow it to mature, and may be particularly useful if a complex repair is planned in the future. […] Cutting setons have been used for many years to manage complex fistula-in-ano. In this procedure, the seton is secured tightly within the fistula tract, with intentional pressure placed on the tract itself. […] Primary fistulotomy has been the mainstay of treatment for the simple anal fistula, and remains extremely useful for intersphincteric and low transsphincteric fistulas. Higher fistulas are potentially a much different problem, though good evidence is lacking. […] The endorectal advancement flap involves mobilizing a partial-thickness flap comprising rectal mucosa, submucosa, and some muscle fibers.

• #33 Anal Fistula Treatment – IFFGD

  https://iffgd.org/gi-disorders/other-disorders/anal-fistulas/anal-fistula-treatment/

  Ligation of the intersphincteric fistula tract (LIFT). This procedure is designed to avoid cutting the sphincter muscle entirely by accessing the fistula between the sphincter muscles and avoid cutting them. This procedure usually follows a seton drain procedure described above. With this procedure, after the seton drain is removed, the surgeon closes, likely with stiches, the part of the fistula between the sphincter muscles. […] Endorectal advancement flap: This procedure is used to reduce the amount of sphincter muscle that is cut by the surgery. In this procedure, the infected tissue around the inside opening of the fistula is removed. A healthy piece of tissue (flap) from the inside of your rectum is cut and the opening of the fistula is covered with it. The fistula should continue to drain and heal from the inside out.

• #34 Anal Fistula Treatment – IFFGD

  https://iffgd.org/gi-disorders/other-disorders/anal-fistulas/anal-fistula-treatment/

  Ligation of the intersphincteric fistula tract (LIFT). This procedure is designed to avoid cutting the sphincter muscle entirely by accessing the fistula between the sphincter muscles and avoid cutting them. This procedure usually follows a seton drain procedure described above. With this procedure, after the seton drain is removed, the surgeon closes, likely with stiches, the part of the fistula between the sphincter muscles. […] Endorectal advancement flap: This procedure is used to reduce the amount of sphincter muscle that is cut by the surgery. In this procedure, the infected tissue around the inside opening of the fistula is removed. A healthy piece of tissue (flap) from the inside of your rectum is cut and the opening of the fistula is covered with it. The fistula should continue to drain and heal from the inside out.

• #35 Fistula-in-Ano Treatment & Management: Approach Considerations, Fistulotomy, Seton Placement

  https://emedicine.medscape.com/article/190234-treatment

  A mucosal advancement flap is reserved for use in patients with chronic high fistula but is indicated for the same disease process as seton use. […] Advances in biotechnology have led to the development of many new tissue adhesives and biomaterials formed as fistula plugs. […] Ligation of the intersphincteric fistula tract (LIFT) is a sphincter-sparing procedure for complex transsphincteric fistulas first described in 2007. […] A retrospective study investigated the use of autologous fat grafting (AFG) in the treatment of complex anal fistulas. […] In rare cases, the creation of a diverting stoma may be indicated to facilitate the treatment of a complex persistent fistula-in-ano. […] After the operation, most patients can be treated in an ambulatory setting with discharge instructions and close follow-up care.

• #36 Anal Fistulas: Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/digestive/anorectal-diseases/anal-fistulas/treatment

  Endorectal Advancement Flap. For anal fistulas that significantly involve the anal sphincter muscles, the surgeon may excise the internal opening of the fistula tract and create a flap of healthy anorectal tissue to cover the internal defect. […] LIFT procedure. For high transphincteric fistulas, the surgeon accesses the fistula tract between the sphincter muscles and ligates the tract in the intersphincteric plane. The external opening is widely drained. The internal opening may be closed with an endorectal advancement flap. […] Fibrin glue. The fistula tract is debrided and then surgeon injects fibrin glue into the fistula to seal it. […] Anal fistula plug. The plug is pulled into the fistula tract. […] Laser surgery. This treatment involves introducing a device into the fistula tract that will emit a laser beam to promote healing of the fistula tract. […] Additional techniques and clinical trials are in development.

• #37 Management of Complex Anal Fistulas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4755767/

  The anal fistula plug (AFP) technique was first described in 2004, with the first case series published in 2006. The technique involves debridement of the fistula tract followed by placement of a bioprosthetic plug within the tract, securing it at the internal opening and cutting it flush with the skin at the external opening. […] The technique that has perhaps gained the most traction in recent years is the LIFT procedure. […] One of the newest technologies on the market is the use of a laser to ablate the fistula tract. […] Anal fistulas after ileal pouch-anal anastomosis are particularly complex, usually resulting from an anastomotic defect. […] There are multiple techniques available for the repair of complex anal fistulas. The best technique is not known, and the available evidence suffers from a lack of high-quality data, with very few large randomized studies.

• #38 Anal Fistula Treatment – IFFGD

  https://iffgd.org/gi-disorders/other-disorders/anal-fistulas/anal-fistula-treatment/

  Filling the fistula with a collagen plug. This is one of two treatments that are non-surgical methods used to treat perianal fistulas without medication. The surgeon cleans the fistula tunnel, and the fistula inner opening is then blocked with a plug of collagen protein. This protein will provide a structure that allows for new tissue growth to close the internal opening of the fistula tract. […] Procedures for Anal fistulas are generally outpatient procedures and patients go home the same day without need for an overnight stay in the hospital. Pain medication is often prescribed following the procedure as the affected area will be sore and painful. Alongside the pain medications, some find taking a sitz bath (sitting in a warm bath) several times a day to be helpful. It will also aid in healing the area faster. The perianal area will likely have a wound dressing which will need to be changed often and kept clean.

• #39 Anal Fistula Treatment – IFFGD

  https://iffgd.org/gi-disorders/other-disorders/anal-fistulas/anal-fistula-treatment/

  Filling the fistula with a collagen plug. This is one of two treatments that are non-surgical methods used to treat perianal fistulas without medication. The surgeon cleans the fistula tunnel, and the fistula inner opening is then blocked with a plug of collagen protein. This protein will provide a structure that allows for new tissue growth to close the internal opening of the fistula tract. […] Procedures for Anal fistulas are generally outpatient procedures and patients go home the same day without need for an overnight stay in the hospital. Pain medication is often prescribed following the procedure as the affected area will be sore and painful. Alongside the pain medications, some find taking a sitz bath (sitting in a warm bath) several times a day to be helpful. It will also aid in healing the area faster. The perianal area will likely have a wound dressing which will need to be changed often and kept clean.

• #40 Fistula-in-Ano Treatment & Management: Approach Considerations, Fistulotomy, Seton Placement

  https://emedicine.medscape.com/article/190234-treatment

  A mucosal advancement flap is reserved for use in patients with chronic high fistula but is indicated for the same disease process as seton use. […] Advances in biotechnology have led to the development of many new tissue adhesives and biomaterials formed as fistula plugs. […] Ligation of the intersphincteric fistula tract (LIFT) is a sphincter-sparing procedure for complex transsphincteric fistulas first described in 2007. […] A retrospective study investigated the use of autologous fat grafting (AFG) in the treatment of complex anal fistulas. […] In rare cases, the creation of a diverting stoma may be indicated to facilitate the treatment of a complex persistent fistula-in-ano. […] After the operation, most patients can be treated in an ambulatory setting with discharge instructions and close follow-up care.

• #41 Anal Fistulas: Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/digestive/anorectal-diseases/anal-fistulas/treatment

  Endorectal Advancement Flap. For anal fistulas that significantly involve the anal sphincter muscles, the surgeon may excise the internal opening of the fistula tract and create a flap of healthy anorectal tissue to cover the internal defect. […] LIFT procedure. For high transphincteric fistulas, the surgeon accesses the fistula tract between the sphincter muscles and ligates the tract in the intersphincteric plane. The external opening is widely drained. The internal opening may be closed with an endorectal advancement flap. […] Fibrin glue. The fistula tract is debrided and then surgeon injects fibrin glue into the fistula to seal it. […] Anal fistula plug. The plug is pulled into the fistula tract. […] Laser surgery. This treatment involves introducing a device into the fistula tract that will emit a laser beam to promote healing of the fistula tract. […] Additional techniques and clinical trials are in development.

• #42 Anal Fistula Treatment – IFFGD

  https://iffgd.org/gi-disorders/other-disorders/anal-fistulas/anal-fistula-treatment/

  Endoscopic ablation: In this procedure, endoscope (a long, thin tube with a small camera on the end) is put in the fistula. An electrode is then passed through the endoscope. This electrode will cauterize the area it touches in the fistula tract. The fistula tract is cauterized from the external opening to the internal opening through a series of electrodes. […] Fistulectomy: In this procedure, the surgeon completely removes the fistula tract. This procedure is rarely used as it increases the likelihood of damage to the anal sphincter muscles. However, it may be necessary in some severe cases where the fistula interferes with normal bowel function, or if there is a high likelihood of recurrence. […] Filling the fistula with fibrin glue: This is one of two treatments that are non-surgical methods used to treat perianal fistulas without medication. While under general anesthesia, the surgeon cleans the fistula tunnel and then closes the internal opening with stiches. The fistula tunnel is then filled with a material, called fibrin glue, which is absorbed into the body while the fistula heals.

• #43 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Anal-Fistula-Treatment.aspx

  It is uncommon for an anal fistula to heal spontaneously. In most cases, surgery is required to treat the condition. The type and technique of surgery will depend on the classification and situation of the fistula. […] The only non-surgical treatment for anal fistula that is currently in use is fibrin glue. This involves an injection of the glue into the fistulous tract to approximate the sides closely together and prevent the space from persisting. Eventually the cells from the surrounding tissue will grow into the glue and the tract will be obliterated. […] Many patients may prefer this method because it is a safe and painless procedure. However, it is less effective than surgical techniques. Some research has suggested that the majority of patients treated by this technique have complications or recurrence within 16 months of treatment.

• #44 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Anal-Fistula-Treatment.aspx

  It is uncommon for an anal fistula to heal spontaneously. In most cases, surgery is required to treat the condition. The type and technique of surgery will depend on the classification and situation of the fistula. […] The only non-surgical treatment for anal fistula that is currently in use is fibrin glue. This involves an injection of the glue into the fistulous tract to approximate the sides closely together and prevent the space from persisting. Eventually the cells from the surrounding tissue will grow into the glue and the tract will be obliterated. […] Many patients may prefer this method because it is a safe and painless procedure. However, it is less effective than surgical techniques. Some research has suggested that the majority of patients treated by this technique have complications or recurrence within 16 months of treatment.

• #45 Anal Fistulas: Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/digestive/anorectal-diseases/anal-fistulas/treatment

  Endorectal Advancement Flap. For anal fistulas that significantly involve the anal sphincter muscles, the surgeon may excise the internal opening of the fistula tract and create a flap of healthy anorectal tissue to cover the internal defect. […] LIFT procedure. For high transphincteric fistulas, the surgeon accesses the fistula tract between the sphincter muscles and ligates the tract in the intersphincteric plane. The external opening is widely drained. The internal opening may be closed with an endorectal advancement flap. […] Fibrin glue. The fistula tract is debrided and then surgeon injects fibrin glue into the fistula to seal it. […] Anal fistula plug. The plug is pulled into the fistula tract. […] Laser surgery. This treatment involves introducing a device into the fistula tract that will emit a laser beam to promote healing of the fistula tract. […] Additional techniques and clinical trials are in development.

• #46 Perianal Abscess & Fistula in Ano – Causes, Treatment & Surgery | Glasgow Colorectal Centre

  https://colorectalcentre.co.uk/abscess-fistula.html

  Fibrin glue. This is currently the only non-surgical treatment option. […] Bioprosthetic plug. This is a cone shaped plug made from human tissue, which is used to block the internal opening of the fistula. […] Most of the time, fistula surgery can be performed on an outpatient basis. Treatment of a deep or extensive fistula may require a short hospital stay. […] If properly healed, the problem will usually not return. However, it is important to follow the directions of a colon and rectal surgeon to help prevent recurrence. […] There is a risk of complications after anal fistula surgery, including: Infection, Bowel incontinence, Recurrence of the anal fistula (i.e. the fistula comes back). […] Glasgow Colorectal Centre surgeons Richard Molloy and Graham MacKay are experienced in the management of patients with perianal abscesses and fistulas.

• #47 Anal Fistula Treatment – IFFGD

  https://iffgd.org/gi-disorders/other-disorders/anal-fistulas/anal-fistula-treatment/

  Endoscopic ablation: In this procedure, endoscope (a long, thin tube with a small camera on the end) is put in the fistula. An electrode is then passed through the endoscope. This electrode will cauterize the area it touches in the fistula tract. The fistula tract is cauterized from the external opening to the internal opening through a series of electrodes. […] Fistulectomy: In this procedure, the surgeon completely removes the fistula tract. This procedure is rarely used as it increases the likelihood of damage to the anal sphincter muscles. However, it may be necessary in some severe cases where the fistula interferes with normal bowel function, or if there is a high likelihood of recurrence. […] Filling the fistula with fibrin glue: This is one of two treatments that are non-surgical methods used to treat perianal fistulas without medication. While under general anesthesia, the surgeon cleans the fistula tunnel and then closes the internal opening with stiches. The fistula tunnel is then filled with a material, called fibrin glue, which is absorbed into the body while the fistula heals.

• #48 Modern Techniques of Anal Fistula Treatment: Relief and Recovery

  https://drkamrava.com/relief-and-recovery-modern-approaches-to-anal-fistula-treatment/

  Anal fistula treatment is designed to treat anal fistulas, a distressing and often painful condition that affects the delicate anatomy of the anal canal. […] Medical advances have revolutionized the approach to anal fistula treatment over the years, providing more effective and minimally invasive options to alleviate symptoms and promote recovery. The following are the primary treatment modalities: […] Fistulotomy: This surgical procedure involves opening the fistula tract with an incision and allowing it to heal from the inside out. […] Fistula Plug: To promote healing and closure, a biologically derived plug is inserted into the fistula tract. […] Laser Treatment: Laser ablation is a minimally invasive technique that uses high-energy light to seal the fistula tract. […] LIFT (Ligation of Intersphincteric Fistula Tract) Procedure: The LIFT (Ligation of Intersphincteric Fistula Tract) procedure involves dissecting the fistula tract and closing it with sutures.

• #49

  https://link.springer.com/article/10.1007/s10151-020-02225-6

  Laser treatment for fistula-in-ano, also known as FiLaCR (fistula laser closure) or LAFT (laser ablation of fistula tract), has gained increasing attention in the last decade. […] Its main indication is the treatment of high fistulas and, in general, of all fistulas where more invasive treatments may impair anal continence. […] The shrinkage of fistula tracts caused by laser depends on the wavelength and the amount of energy of the laser beam delivered within the tract. […] In our experience, we found that curettage and insertion of a silastic drain in the lumen of the fistula in a first-stage operation as bridge to laser treatment (second stage, 12 weeks later) may induce the formation of fibrotic tissue, modeling the fistula around the draining loop. […] The length of the fistula tract may also play a role in influencing the success rate.

• #50 Anal fistula – The best method of treatment | Proctoclinic.gr

  https://proctoclinic.gr/en/suriggio-proktou-apostima-proktou/

  Fistula-tract laser closure (FiLaC) is a sphincter-saving technique using a radial emitting laser fiber to obliterate the fistula. […] Ligation of Intersphincteric Fistula Tract or LIFT procedure appears to be safe and effective with relatively little injury to the area. Anal fistula plug insertion and fibrin glue, on the other hand, have limited use and low healing rates. […] The use of a novel diode laser source and a radial emitting laser probe in addition to conventional surgery is a very promising new technique in sphincter-preserving anal fistula repair. The observed healing rate is high. Due to minimized trauma to the sphincter muscle, there are good short-term functional results without observable procedure-related complications. […] FiLaC is a novel technique that was developed using a newly invented radial emitting laser probe to destroy the fistula epithelium and to simultaneously obliterate the remaining fistula track.

• #51

  https://link.springer.com/article/10.1007/s10151-020-02225-6

  Laser treatment for fistula-in-ano, also known as FiLaCR (fistula laser closure) or LAFT (laser ablation of fistula tract), has gained increasing attention in the last decade. […] Its main indication is the treatment of high fistulas and, in general, of all fistulas where more invasive treatments may impair anal continence. […] The shrinkage of fistula tracts caused by laser depends on the wavelength and the amount of energy of the laser beam delivered within the tract. […] In our experience, we found that curettage and insertion of a silastic drain in the lumen of the fistula in a first-stage operation as bridge to laser treatment (second stage, 12 weeks later) may induce the formation of fibrotic tissue, modeling the fistula around the draining loop. […] The length of the fistula tract may also play a role in influencing the success rate.

• #52 Anal Fistula: What It Is, Symptoms, Treatment & Surgery

  https://my.clevelandclinic.org/health/diseases/14466-anal-fistula

  If your anal fistula involves only a minimal amount of muscle and doesn’t have any branches, it’s considered a simple fistula. The surgical treatment for a simple fistula is called a fistulotomy. This one-and-done procedure is the easiest and the most effective way to treat an anal fistula (about 95%). […] Your fistula is considered complex if it involves a significant amount of muscle, if it has branches or if you have preexisting conditions that raise your risk of complications from surgery. Complex fistulas may require multiple surgeries to fix. […] The main risks are: Recurring infection. If the infection isn’t completely gone from your fistula, it may continue inside your healing fistula. […] Anal fistula procedures are generally outpatient procedures, so you can go home the same day, although some people will need to return for more surgery later. You’ll have prescription pain medication to take home with you, along with some instructions for self-care.

• #53 Management of Complex Anal Fistulas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4755767/

  Complex anal fistulas require careful evaluation. Prior to any attempts at definitive repair, the anatomy must be well defined and the sepsis resolved. Several muscle-sparing approaches to anal fistula are appropriate, and are often catered to the patient based on their presentation and previous repairs. Emerging technologies show promise for fistula repair, but lack long-term data. […] The initial management strategy prior to any definitive treatment is to have local control of perianal sepsis, particularly if an abscess exists. This may include draining an abscess cavity or placing a draining seton into the fistula to allow the area to cool off. Definitive repair in the setting of active infection often leads to lower healing rates. […] Definitive management requires addressing the underlying fistula tract itself. Options include setons (temporary draining, cutting), fistulotomy or fistulectomy (primary or staged, with or without sphincteroplasty), endorectal advancement flap, anocutaneous advancement flap, fistula plug, fibrin glue, electrocauterization of tract/laser (fistula laser closure [FiLaC]), and ligation of intersphincteric fistula tract (LIFT). Each of these will be discussed individually in the text that follows.

• #54 Anal Fistula: What It Is, Symptoms, Treatment & Surgery

  https://my.clevelandclinic.org/health/diseases/14466-anal-fistula

  If your anal fistula involves only a minimal amount of muscle and doesn’t have any branches, it’s considered a simple fistula. The surgical treatment for a simple fistula is called a fistulotomy. This one-and-done procedure is the easiest and the most effective way to treat an anal fistula (about 95%). […] Your fistula is considered complex if it involves a significant amount of muscle, if it has branches or if you have preexisting conditions that raise your risk of complications from surgery. Complex fistulas may require multiple surgeries to fix. […] The main risks are: Recurring infection. If the infection isn’t completely gone from your fistula, it may continue inside your healing fistula. […] Anal fistula procedures are generally outpatient procedures, so you can go home the same day, although some people will need to return for more surgery later. You’ll have prescription pain medication to take home with you, along with some instructions for self-care.

• #55 Management of Complex Anal Fistulas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4755767/

  Complex anal fistulas require careful evaluation. Prior to any attempts at definitive repair, the anatomy must be well defined and the sepsis resolved. Several muscle-sparing approaches to anal fistula are appropriate, and are often catered to the patient based on their presentation and previous repairs. Emerging technologies show promise for fistula repair, but lack long-term data. […] The initial management strategy prior to any definitive treatment is to have local control of perianal sepsis, particularly if an abscess exists. This may include draining an abscess cavity or placing a draining seton into the fistula to allow the area to cool off. Definitive repair in the setting of active infection often leads to lower healing rates. […] Definitive management requires addressing the underlying fistula tract itself. Options include setons (temporary draining, cutting), fistulotomy or fistulectomy (primary or staged, with or without sphincteroplasty), endorectal advancement flap, anocutaneous advancement flap, fistula plug, fibrin glue, electrocauterization of tract/laser (fistula laser closure [FiLaC]), and ligation of intersphincteric fistula tract (LIFT). Each of these will be discussed individually in the text that follows.

• #56 How to treat an anal fistula – THDLAB – COM | THD

  https://www.thdlab.com/patients/treatments/how-to-treat-anal-fistulae

  Seton: For deeper and more extensive anal fistulae, multi-stage surgery is used. The operation occurs in multiple stages in order to avoid damaging the anal sphincter. […] Closure with fibrin glue, collagen or plugs: The surgeon injects a substance called fibrin glue into the anal fistula to help it close. […] Minimally invasive techniques: LIFT and VAAFT: In recent years new minimally invasive surgical techniques have been developed.

• #57 Management of Complex Anal Fistulas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4755767/

  Complex anal fistulas require careful evaluation. Prior to any attempts at definitive repair, the anatomy must be well defined and the sepsis resolved. Several muscle-sparing approaches to anal fistula are appropriate, and are often catered to the patient based on their presentation and previous repairs. Emerging technologies show promise for fistula repair, but lack long-term data. […] The initial management strategy prior to any definitive treatment is to have local control of perianal sepsis, particularly if an abscess exists. This may include draining an abscess cavity or placing a draining seton into the fistula to allow the area to cool off. Definitive repair in the setting of active infection often leads to lower healing rates. […] Definitive management requires addressing the underlying fistula tract itself. Options include setons (temporary draining, cutting), fistulotomy or fistulectomy (primary or staged, with or without sphincteroplasty), endorectal advancement flap, anocutaneous advancement flap, fistula plug, fibrin glue, electrocauterization of tract/laser (fistula laser closure [FiLaC]), and ligation of intersphincteric fistula tract (LIFT). Each of these will be discussed individually in the text that follows.

• #58 Recent advances in the diagnosis and treatment of complex anal fistula

  https://www.coloproctol.org/journal/view.php?number=2057

  Fistulotomy has the highest cure rate among all known procedures, with an impressive 96% to 99% success rate. However, it remains highly underutilized due to surgeons’ concerns about incontinence. […] The TROPIS procedure, a recently developed sphincter-preserving technique, stands out as the most promising of these approaches for managing complex anal fistulas. […] The LIFT procedure has been popular for over a decade as a sphincter-sparing procedure for the treatment of complex fistula. […] The loose draining seton continues to play a role in the management of anal fistulas, serving as an adjunct to other procedures, and in the treatment of acute abscesses. However, the cutting seton also remains in use in many regions globally. […] Platelet-rich plasma (PRP) has shown positive results when used as an adjunct to other procedures. […] Stem cell therapy could represent a novel therapeutic approach for complex perianal fistulas, demonstrating high efficacy in the short term.

• #59 Anal fistula – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anal-fistula/diagnosis-treatment/drc-20537243

  To diagnose an anal fistula, your health care provider will discuss your symptoms and do a physical exam. The goals are to repair the anal fistula completely to prevent recurrence and to protect the sphincter muscles. Although surgery is usually required, sometimes nonsurgical treatments may be an option. Surgical options include: Fistulotomy. The surgeon cuts the fistula’s internal opening, scrapes and flushes out the infected tissue, and then flattens the tunnel and stitches it in place. Nonsurgical options include: Seton placement. The surgeon places a seton into the fistula to help drain the infection. This allows the tunnel to heal. In cases of complex anal fistula, more-invasive surgical procedures may be recommended, including: Ostomy and stoma. The surgeon creates a temporary opening in the abdomen to divert the intestines away from the anal canal. This procedure allows the anal area time to heal. […] Treatment of an anal fistula depends on the fistula’s location and complexity and its cause.

• #60 Fistula-in-Ano Treatment & Management: Approach Considerations, Fistulotomy, Seton Placement

  https://emedicine.medscape.com/article/190234-treatment

  A mucosal advancement flap is reserved for use in patients with chronic high fistula but is indicated for the same disease process as seton use. […] Advances in biotechnology have led to the development of many new tissue adhesives and biomaterials formed as fistula plugs. […] Ligation of the intersphincteric fistula tract (LIFT) is a sphincter-sparing procedure for complex transsphincteric fistulas first described in 2007. […] A retrospective study investigated the use of autologous fat grafting (AFG) in the treatment of complex anal fistulas. […] In rare cases, the creation of a diverting stoma may be indicated to facilitate the treatment of a complex persistent fistula-in-ano. […] After the operation, most patients can be treated in an ambulatory setting with discharge instructions and close follow-up care.

• #61 Anal Fistula

  https://austinregionalclinic.staywellsolutionsonline.com/Search/134,173

  Once you have an anal fistula, antibiotics alone won’t get rid of it. You’ll need to have surgery to treat the fistula. Surgical treatment includes: […] Anal fistulas are very common in people with Crohns disease. For those with both Crohn’s disease and a fistula, medical therapy is often tried before surgery. […] Antibiotics alone won’t fix it. You will need to have surgery to cure the fistula.

• #62 Management of Complex Anal Fistulas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4755767/

  The anal fistula plug (AFP) technique was first described in 2004, with the first case series published in 2006. The technique involves debridement of the fistula tract followed by placement of a bioprosthetic plug within the tract, securing it at the internal opening and cutting it flush with the skin at the external opening. […] The technique that has perhaps gained the most traction in recent years is the LIFT procedure. […] One of the newest technologies on the market is the use of a laser to ablate the fistula tract. […] Anal fistulas after ileal pouch-anal anastomosis are particularly complex, usually resulting from an anastomotic defect. […] There are multiple techniques available for the repair of complex anal fistulas. The best technique is not known, and the available evidence suffers from a lack of high-quality data, with very few large randomized studies.

• #63 Anal fistula – Treating an anal fistula

  https://www.ibdrelief.com/learn/treatment/surgery/treating-an-anal-fistula

  In a LIFT procedure the surgeon makes a small cut in the skin above the fistula. […] A small camera is used to see inside the fistula tract. […] In this non-surgical procedure done under general anaesthetic fibrin glue is injected into the fistula. […] If the fistula/s is as a result of Crohns disease (fistulizing Crohns disease) then often a combination of medication and surgery is required. […] These may be used to clear any infection related to the fistula or abscess. […] Anti-TNFs may be used to help with fistula drainage and support fistula closure in people who have Crohns disease. […] It has been found that people who had a combination of both infliximab and surgery saw their fistula heal quicker and had a longer time to relapse in the case of complex fistulas than those who had just surgery or used infliximab alone. […] Thiopurines, such as a azathioprine or 6-mercaptopurine (6-MP), may be used to treat perianal fistulas in people with Crohns disease.

• #64 Fistula-in-Ano Treatment & Management: Approach Considerations, Fistulotomy, Seton Placement

  https://emedicine.medscape.com/article/190234-treatment

  Therapeutic intervention is indicated for symptomatic patients. Symptoms usually involve recurrent episodes of anorectal sepsis. An abscess develops easily if the external opening on the perianal skin seals itself. […] Surgery for fistula-in-ano should not be performed for definitive repair of the fistula in the setting of anorectal abscess (unless the fistula is superficial and the tract is obvious). In the acute phase, simple incision and drainage of the abscess are sufficient. […] Studies have identified a role in Crohn disease for fistula therapy with infliximab, with 50-60% response rates for perianal fistulas. […] Adipose-derived stem-cell therapy is being studied for use in the treatment of Crohn fistula and other complex fistulas. […] A seton can be placed alone, in combination with fistulotomy, or in a staged fashion. This technique is useful in patients with complex fistulas (ie, high transsphincteric, suprasphincteric, extrasphincteric) or multiple fistulas.

• #65 Anal fistula – Treating an anal fistula

  https://www.ibdrelief.com/learn/treatment/surgery/treating-an-anal-fistula

  In a LIFT procedure the surgeon makes a small cut in the skin above the fistula. […] A small camera is used to see inside the fistula tract. […] In this non-surgical procedure done under general anaesthetic fibrin glue is injected into the fistula. […] If the fistula/s is as a result of Crohns disease (fistulizing Crohns disease) then often a combination of medication and surgery is required. […] These may be used to clear any infection related to the fistula or abscess. […] Anti-TNFs may be used to help with fistula drainage and support fistula closure in people who have Crohns disease. […] It has been found that people who had a combination of both infliximab and surgery saw their fistula heal quicker and had a longer time to relapse in the case of complex fistulas than those who had just surgery or used infliximab alone. […] Thiopurines, such as a azathioprine or 6-mercaptopurine (6-MP), may be used to treat perianal fistulas in people with Crohns disease.

• #66 Recent advances in the diagnosis and treatment of complex anal fistula

  https://www.coloproctol.org/journal/view.php?number=2057

  Fistulotomy has the highest cure rate among all known procedures, with an impressive 96% to 99% success rate. However, it remains highly underutilized due to surgeons’ concerns about incontinence. […] The TROPIS procedure, a recently developed sphincter-preserving technique, stands out as the most promising of these approaches for managing complex anal fistulas. […] The LIFT procedure has been popular for over a decade as a sphincter-sparing procedure for the treatment of complex fistula. […] The loose draining seton continues to play a role in the management of anal fistulas, serving as an adjunct to other procedures, and in the treatment of acute abscesses. However, the cutting seton also remains in use in many regions globally. […] Platelet-rich plasma (PRP) has shown positive results when used as an adjunct to other procedures. […] Stem cell therapy could represent a novel therapeutic approach for complex perianal fistulas, demonstrating high efficacy in the short term.

• #67 Recent advances in the diagnosis and treatment of complex anal fistula

  https://www.coloproctol.org/journal/view.php?number=2057

  Fistulotomy has the highest cure rate among all known procedures, with an impressive 96% to 99% success rate. However, it remains highly underutilized due to surgeons’ concerns about incontinence. […] The TROPIS procedure, a recently developed sphincter-preserving technique, stands out as the most promising of these approaches for managing complex anal fistulas. […] The LIFT procedure has been popular for over a decade as a sphincter-sparing procedure for the treatment of complex fistula. […] The loose draining seton continues to play a role in the management of anal fistulas, serving as an adjunct to other procedures, and in the treatment of acute abscesses. However, the cutting seton also remains in use in many regions globally. […] Platelet-rich plasma (PRP) has shown positive results when used as an adjunct to other procedures. […] Stem cell therapy could represent a novel therapeutic approach for complex perianal fistulas, demonstrating high efficacy in the short term.

• #68 Recent advances in the diagnosis and treatment of complex anal fistula

  https://coloproctol.org/journal/view.php?doi=10.3393/ac.2024.00325.0046

  The TROPIS procedure, a recently developed sphincter-preserving technique, stands out as the most promising of these approaches for managing complex anal fistulas. […] The LIFT procedure has been popular for over a decade as a sphincter-sparing procedure for the treatment of complex fistula. […] These device-based procedures primarily aim to manage the external aspects of fistula tracts without addressing the intersphincteric portion. Consequently, these procedures tend to have moderate success in treating simple low fistulas, which typically have minimal or no intersphincteric involvement, while they exhibit a lower success rate in managing complex high fistulas, which typically include a segment of the fistula tract within the intersphincteric plane. […] Platelet-rich plasma (PRP) has shown positive results when used as an adjunct to other procedures. […] Stem cell therapy could represent a novel therapeutic approach for complex perianal fistulas, demonstrating high efficacy in the short term.

• #69 New Treatments for Anal Fistula – Stem Cells & More: Karen Zaghiyan, MD, FACS, FASCRS: Colorectal Surgeon

  https://www.karenzaghiyanmd.com/blog/new-treatments-for-anal-fistula-stem-cells-more

  In individuals with a complex fistula which tunnels through the sphincter muscles, alternative repair options exist (most commonly LIFT or advancement flap surgery). These surgeries offer reasonable success rates (approximately 80% in non-Crohns and 60% in Crohns) and avoid damage to the sphincter muscles. […] The use of mesenchymal stem cells to treat anal fistula has intrigued scientists for some time. […] Currently, mesenchymal stem cells are not FDA approved for treatment of Crohns perianal fistula or non-Crohns anal fistula but I hope that approval is on the horizon. […] As a colorectal surgeon and researcher, I have remained on the forefront of stem cell therapy for anal fistula through my participation in several clinical trials. […] The ADMIRE-CD clinical trial, published in 2018, was a phase-III, randomized, placebo controlled clinical trial, in patients with Crohns anal fistula, evaluating allogenic, adipose-derived stem cells.

• #70 Fistula-in-Ano Treatment & Management: Approach Considerations, Fistulotomy, Seton Placement

  https://emedicine.medscape.com/article/190234-treatment

  A mucosal advancement flap is reserved for use in patients with chronic high fistula but is indicated for the same disease process as seton use. […] Advances in biotechnology have led to the development of many new tissue adhesives and biomaterials formed as fistula plugs. […] Ligation of the intersphincteric fistula tract (LIFT) is a sphincter-sparing procedure for complex transsphincteric fistulas first described in 2007. […] A retrospective study investigated the use of autologous fat grafting (AFG) in the treatment of complex anal fistulas. […] In rare cases, the creation of a diverting stoma may be indicated to facilitate the treatment of a complex persistent fistula-in-ano. […] After the operation, most patients can be treated in an ambulatory setting with discharge instructions and close follow-up care.

• #71 Anal Fistula Treatment – IFFGD

  https://iffgd.org/gi-disorders/other-disorders/anal-fistulas/anal-fistula-treatment/

  Filling the fistula with a collagen plug. This is one of two treatments that are non-surgical methods used to treat perianal fistulas without medication. The surgeon cleans the fistula tunnel, and the fistula inner opening is then blocked with a plug of collagen protein. This protein will provide a structure that allows for new tissue growth to close the internal opening of the fistula tract. […] Procedures for Anal fistulas are generally outpatient procedures and patients go home the same day without need for an overnight stay in the hospital. Pain medication is often prescribed following the procedure as the affected area will be sore and painful. Alongside the pain medications, some find taking a sitz bath (sitting in a warm bath) several times a day to be helpful. It will also aid in healing the area faster. The perianal area will likely have a wound dressing which will need to be changed often and kept clean.

• #72 Anal fistula treatment – Recovery | Guy’s and St Thomas’ NHS Foundation Trust

  https://www.guysandstthomas.nhs.uk/health-information/anal-fistula-treatment/recovery

  We treat an anal fistula with surgery under a general anaesthetic (a medicine that makes you sleep and stops you feeling pain). Most people can leave hospital on the same day as the surgery. […] If your fistula is complex (branches in different directions), you might need to stay in hospital overnight. […] Your surgeon may ask you to digitate your wound. You move a finger along your wound to prevent the top layer of skin from healing too quickly. This might be uncomfortable, but can help to stop your fistula coming back. […] We might give you antibiotics to prevent infection and ease your pain. […] We might give you laxatives to help you go to the toilet. Laxatives help you to poo and to keep your poo soft. […] No routine follow up appointment is required unless specified by the surgeon.

• #73 Anal Fistula Treatment — Colorectal Clinic of Tampa Bay

  https://www.tampacolorectal.com/anal-fistula

  Other procedures include placing material within the fistula tract to occlude it or surgically altering the surrounding tissue to accomplish closure of the fistula, with the choice of procedure depending upon the type, length, and location of the fistula. […] Pain after surgery is controlled with pain pills, fiber and bulk laxatives. Patients should plan for time at home using sitz baths and attempt to avoid the constipation that can be associated with prescription pain medication. However, despite proper and indicated open or minimally invasive treatment, both abscesses and fistulas can potentially recur.

• #74 Anal Fistula Treatment – IFFGD

  https://iffgd.org/gi-disorders/other-disorders/anal-fistulas/anal-fistula-treatment/

  Filling the fistula with a collagen plug. This is one of two treatments that are non-surgical methods used to treat perianal fistulas without medication. The surgeon cleans the fistula tunnel, and the fistula inner opening is then blocked with a plug of collagen protein. This protein will provide a structure that allows for new tissue growth to close the internal opening of the fistula tract. […] Procedures for Anal fistulas are generally outpatient procedures and patients go home the same day without need for an overnight stay in the hospital. Pain medication is often prescribed following the procedure as the affected area will be sore and painful. Alongside the pain medications, some find taking a sitz bath (sitting in a warm bath) several times a day to be helpful. It will also aid in healing the area faster. The perianal area will likely have a wound dressing which will need to be changed often and kept clean.

• #75 Anal fistula treatment – Recovery | Guy’s and St Thomas’ NHS Foundation Trust

  https://www.guysandstthomas.nhs.uk/health-information/anal-fistula-treatment/recovery

  We treat an anal fistula with surgery under a general anaesthetic (a medicine that makes you sleep and stops you feeling pain). Most people can leave hospital on the same day as the surgery. […] If your fistula is complex (branches in different directions), you might need to stay in hospital overnight. […] Your surgeon may ask you to digitate your wound. You move a finger along your wound to prevent the top layer of skin from healing too quickly. This might be uncomfortable, but can help to stop your fistula coming back. […] We might give you antibiotics to prevent infection and ease your pain. […] We might give you laxatives to help you go to the toilet. Laxatives help you to poo and to keep your poo soft. […] No routine follow up appointment is required unless specified by the surgeon.

• #76 Anal Fistula Treatment — Colorectal Clinic of Tampa Bay

  https://www.tampacolorectal.com/anal-fistula

  Other procedures include placing material within the fistula tract to occlude it or surgically altering the surrounding tissue to accomplish closure of the fistula, with the choice of procedure depending upon the type, length, and location of the fistula. […] Pain after surgery is controlled with pain pills, fiber and bulk laxatives. Patients should plan for time at home using sitz baths and attempt to avoid the constipation that can be associated with prescription pain medication. However, despite proper and indicated open or minimally invasive treatment, both abscesses and fistulas can potentially recur.

• #77 Anal Fistula: What It Is, Symptoms, Treatment & Surgery

  https://my.clevelandclinic.org/health/diseases/14466-anal-fistula

  Your outlook will depend on how simple or complex your anal fistula is. This determines how extensive the treatment and recovery process will be. In general, you can expect to spend three to six weeks recovering from one or several surgeries. Some fistulas return after surgery, especially if they had many branches or they were caused by a chronic condition.

• #78

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=ud1325

  You had an anal fistulotomy. This surgery opens and drains an anal fistula and helps it heal. […] Most people can go back to work and their normal routine 1 to 2 weeks after surgery. It will probably take several weeks to several months for your fistula to completely heal. This depends on the size of your fistula and how much surgery you had. […] You may have gauze and bandages over the opening of your fistula, and you may have a string coming from the fistula called a seton drain. The seton drain can help relieve symptoms and mark the fistula for doctors to fix later. It may stay in place for 6 weeks or longer. Your doctor will tell you how to take care of your fistula after surgery. […] Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line if you are having problems.

• #79 Surgery for anal fistula | healthdirect

  https://www.healthdirect.gov.au/surgery/surgery-for-anal-fistula

  If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health. […] Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight. […] Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice. […] Some complications can be serious and can even cause death. […] Most people make a full recovery and can return to normal activities. For a small number of people the fistula can come back. […] An anal fistula can cause continued infection and pain. Symptoms usually get worse without surgery.

• #80 Anal Fistula: What It Is, Symptoms, Treatment & Surgery

  https://my.clevelandclinic.org/health/diseases/14466-anal-fistula

  If your anal fistula involves only a minimal amount of muscle and doesn’t have any branches, it’s considered a simple fistula. The surgical treatment for a simple fistula is called a fistulotomy. This one-and-done procedure is the easiest and the most effective way to treat an anal fistula (about 95%). […] Your fistula is considered complex if it involves a significant amount of muscle, if it has branches or if you have preexisting conditions that raise your risk of complications from surgery. Complex fistulas may require multiple surgeries to fix. […] The main risks are: Recurring infection. If the infection isn’t completely gone from your fistula, it may continue inside your healing fistula. […] Anal fistula procedures are generally outpatient procedures, so you can go home the same day, although some people will need to return for more surgery later. You’ll have prescription pain medication to take home with you, along with some instructions for self-care.

• #81 Fistula-in-Ano Treatment & Management: Approach Considerations, Fistulotomy, Seton Placement

  https://emedicine.medscape.com/article/190234-treatment

  Early postoperative complications may include urinary retention, bleeding, fecal impaction, and thrombosed hemorrhoids. […] Delayed postoperative complications may include recurrence, incontinence (stool), anal stenosis, and delayed wound healing. […] Postoperative rates of recurrence and incontinence vary according to the procedure performed.

• #82 Anal fistula treatment – Overview | Guy’s and St Thomas’ NHS Foundation Trust

  https://www.guysandstthomas.nhs.uk/health-information/anal-fistula-treatment

  Fistulas rarely heal by themselves. Surgery is the only way to treat them. […] Surgery is the only way to treat a fistula. The aim of surgery is to help your symptoms, and remove the tunnels and any infection. If you do not have the surgery, your fistula is unlikely to heal. […] Your surgeon talks to you about surgery and recommends the best option for you. […] During surgery, we cut or 'lay open’ the infected tunnel to stop unhealed pockets of infection from being trapped inside. […] You have surgery for an anal fistula under a general anaesthetic. This is a medicine that makes you sleep and stops you feeling any pain during the procedure. […] In most cases, surgery does not involve cutting a big section of the anal sphincter muscles. However, any damage to these muscles can make it harder for you to control wind or poo (bowel incontinence). […] After surgery there is a risk of: pain, infection, bleeding, fistula returning.

• #83

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=ud1325

  You had an anal fistulotomy. This surgery opens and drains an anal fistula and helps it heal. […] Most people can go back to work and their normal routine 1 to 2 weeks after surgery. It will probably take several weeks to several months for your fistula to completely heal. This depends on the size of your fistula and how much surgery you had. […] You may have gauze and bandages over the opening of your fistula, and you may have a string coming from the fistula called a seton drain. The seton drain can help relieve symptoms and mark the fistula for doctors to fix later. It may stay in place for 6 weeks or longer. Your doctor will tell you how to take care of your fistula after surgery. […] Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line if you are having problems.

• #84 Surgery for anal fistula | healthdirect

  https://www.healthdirect.gov.au/surgery/surgery-for-anal-fistula

  If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health. […] Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight. […] Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice. […] Some complications can be serious and can even cause death. […] Most people make a full recovery and can return to normal activities. For a small number of people the fistula can come back. […] An anal fistula can cause continued infection and pain. Symptoms usually get worse without surgery.

• #85 Recent advances in the diagnosis and treatment of complex anal fistula

  https://coloproctol.org/journal/view.php?doi=10.3393/ac.2024.00325.0046

  The aim of the surgical treatment of anal fistula is to achieve definitive healing through closure, obliteration, or excision of the fistula tract while avoiding fecal incontinence (FI). […] Fistulotomy remains the gold standard for treating low fistulas. However, this procedure is highly underutilized due to concerns about incontinence. This underutilization is regrettable, considering that fistulotomy is associated with the highest success rates, ranging from 95% to 100%. […] The Garg classification effectively addresses this concern. Additionally, fistulotomy is a technically straightforward procedure and is widely performed by general surgeons around the world, especially in developing countries. […] Fistulotomy has the highest cure rate among all known procedures, with an impressive 96% to 99% success rate. However, it remains highly underutilized due to surgeons’ concerns about incontinence.

• #86 Recent advances in the diagnosis and treatment of complex anal fistula

  https://www.coloproctol.org/journal/view.php?number=2057

  Fistulotomy has the highest cure rate among all known procedures, with an impressive 96% to 99% success rate. However, it remains highly underutilized due to surgeons’ concerns about incontinence. […] The TROPIS procedure, a recently developed sphincter-preserving technique, stands out as the most promising of these approaches for managing complex anal fistulas. […] The LIFT procedure has been popular for over a decade as a sphincter-sparing procedure for the treatment of complex fistula. […] The loose draining seton continues to play a role in the management of anal fistulas, serving as an adjunct to other procedures, and in the treatment of acute abscesses. However, the cutting seton also remains in use in many regions globally. […] Platelet-rich plasma (PRP) has shown positive results when used as an adjunct to other procedures. […] Stem cell therapy could represent a novel therapeutic approach for complex perianal fistulas, demonstrating high efficacy in the short term.

• #87 Fistula surgery: What to expect, recovery, risks, and more

  https://www.medicalnewstoday.com/articles/fistula-surgery

  Following fistula treatment, a person may experience cramping, nausea, constipation, diarrhea, soreness around the site of the wound. […] However, for most people, fistula surgery is effective, and recurrence rates are low. For example, the long-term success rate of a fistulotomy is 92-97%. […] With so many surgical treatment options, a fistula is rarely permanent.

• #88 Anal Fistula: What It Is, Symptoms, Treatment & Surgery

  https://my.clevelandclinic.org/health/diseases/14466-anal-fistula

  Your outlook will depend on how simple or complex your anal fistula is. This determines how extensive the treatment and recovery process will be. In general, you can expect to spend three to six weeks recovering from one or several surgeries. Some fistulas return after surgery, especially if they had many branches or they were caused by a chronic condition.

• #89 Anal Fistula – Symptoms, Diagnosis and Treatment

  https://www.samitivejhospitals.com/page/Anal-fistula-diagnosis-treatment-South-Asia

  Patient practices and self-care of postoperative wounds are important aspects in minimizing the chance of recurrence. […] In the case of simple fistula surgery, doctors recommend postoperative care of the wound in order to prevent recurrence. […] In the case of complex fistula surgery, regardless of the surgical method employed, patients will have a 20-30 percent chance of recurrence.

• #90 Anal Fistula – Symptoms, Diagnosis and Treatment

  https://www.samitivejhospitals.com/article/detail/Anal-fistula-diagnosis-treatment

  In the case of deep or multi-tract fistulas, the fistula tract cannot be removed entirely, as this would require too much of the sphincter muscle to be excised resulting in fecal incontinence. For this reason, other surgical methods are necessary. […] Of the 4 surgical methods outlined above, there is no method considered to be 100% effective. Rather, each of these has about 60-70% effectiveness; that is, there is still some chance of recurrence. […] A key priority for doctors will be to avoid fecal incontinence caused by the removal of too much of the sphincter muscles or cutting into them. […] Patient practices and self-care of postoperative wounds are important aspects in minimizing the chance of recurrence. […] In the case of simple fistula surgery, doctors recommend postoperative care of the wound in order to prevent recurrence. […] In the case of complex fistula surgery, regardless of the surgical method employed, patients will have a 20-30 percent chance of recurrence.

• #91 Anal Fistula – Symptoms, Diagnosis and Treatment

  https://www.samitivejhospitals.com/page/Anal-fistula-diagnosis-treatment-South-Asia

  Patient practices and self-care of postoperative wounds are important aspects in minimizing the chance of recurrence. […] In the case of simple fistula surgery, doctors recommend postoperative care of the wound in order to prevent recurrence. […] In the case of complex fistula surgery, regardless of the surgical method employed, patients will have a 20-30 percent chance of recurrence.

• #92 Anal Fistula – Symptoms, Diagnosis and Treatment

  https://www.samitivejhospitals.com/article/detail/Anal-fistula-diagnosis-treatment

  In the case of deep or multi-tract fistulas, the fistula tract cannot be removed entirely, as this would require too much of the sphincter muscle to be excised resulting in fecal incontinence. For this reason, other surgical methods are necessary. […] Of the 4 surgical methods outlined above, there is no method considered to be 100% effective. Rather, each of these has about 60-70% effectiveness; that is, there is still some chance of recurrence. […] A key priority for doctors will be to avoid fecal incontinence caused by the removal of too much of the sphincter muscles or cutting into them. […] Patient practices and self-care of postoperative wounds are important aspects in minimizing the chance of recurrence. […] In the case of simple fistula surgery, doctors recommend postoperative care of the wound in order to prevent recurrence. […] In the case of complex fistula surgery, regardless of the surgical method employed, patients will have a 20-30 percent chance of recurrence.

• #93 Anal Fistula: What It Is, Symptoms, Treatment & Surgery

  https://my.clevelandclinic.org/health/diseases/14466-anal-fistula

  Your outlook will depend on how simple or complex your anal fistula is. This determines how extensive the treatment and recovery process will be. In general, you can expect to spend three to six weeks recovering from one or several surgeries. Some fistulas return after surgery, especially if they had many branches or they were caused by a chronic condition.

• #94 Fistula surgery: What to expect, recovery, risks, and more

  https://www.medicalnewstoday.com/articles/fistula-surgery

  Following fistula treatment, a person may experience cramping, nausea, constipation, diarrhea, soreness around the site of the wound. […] However, for most people, fistula surgery is effective, and recurrence rates are low. For example, the long-term success rate of a fistulotomy is 92-97%. […] With so many surgical treatment options, a fistula is rarely permanent.

• #95

  https://link.springer.com/article/10.1007/s10151-020-02225-6

  One of the most important regards the closure of the internal opening. […] Another controversial point is how much energy we should use to close the fistula. […] The effect of laser within the lumen of the fistula is not visible. […] By intuition, the distal part of the fistula, partly crossing the ischiorectal fossa, extending from the external margin of the external sphincter to the external orifice of the fistula has lower potential for successful shrinkage by means of laser. […] Interestingly, a downgrading in the fistulas height after laser treatment was reported in some studies. […] Finally, it is very interesting that most studies report significant improvement of the severity of symptoms even in those patients who experience reduced yet persistent discharge from the external orifice.

• #96 Anal Fistula: What It Is, Symptoms, Treatment & Surgery

  https://my.clevelandclinic.org/health/diseases/14466-anal-fistula

  An anal fistula is usually a side effect of an anal abscess, an infected wound that drains pus from your anus. Surgery is the primary treatment. […] Most anal fistulas will require surgery to fix. Spontaneous healing is usually followed by recurring infections and abscesses that reopen the fistula. However, if your fistula is caused by inflammatory bowel disease and isn’t infected, it’ll occasionally heal with medical treatment. Your provider might try treatment with an immunomodulator, like infliximab, before resorting to surgery for these fistulas. […] Anal fistula surgery can be simple or complex, depending on how simple or complex the fistula is. The most common anal fistulas are simple, intersphincteric fistulas, which only involve a small amount of muscle. These are safe to treat in a single operation. More complex fistulas may need surgery in stages.

• #97 Anal fistula – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anal-fistula/diagnosis-treatment/drc-20537243

  To diagnose an anal fistula, your health care provider will discuss your symptoms and do a physical exam. The goals are to repair the anal fistula completely to prevent recurrence and to protect the sphincter muscles. Although surgery is usually required, sometimes nonsurgical treatments may be an option. Surgical options include: Fistulotomy. The surgeon cuts the fistula’s internal opening, scrapes and flushes out the infected tissue, and then flattens the tunnel and stitches it in place. Nonsurgical options include: Seton placement. The surgeon places a seton into the fistula to help drain the infection. This allows the tunnel to heal. In cases of complex anal fistula, more-invasive surgical procedures may be recommended, including: Ostomy and stoma. The surgeon creates a temporary opening in the abdomen to divert the intestines away from the anal canal. This procedure allows the anal area time to heal. […] Treatment of an anal fistula depends on the fistula’s location and complexity and its cause.

• #98 Recent advances in the diagnosis and treatment of complex anal fistula

  https://www.coloproctol.org/journal/view.php?number=2057

  Anal fistula can be a challenging condition to manage, with complex fistulas presenting even greater difficulties. The primary concerns in treating this condition are a risk of damage to the anal sphincters, which can compromise fecal continence, and refractoriness to treatment, as evidenced by a high recurrence rate. Furthermore, the treatment of complex anal fistula involves several additional challenges. Satisfactory solutions to many of these obstacles remain elusive, and no consensus has been established regarding the available treatment options. In summary, complex anal fistula has no established gold-standard treatment, and the quest for effective therapies continues. This review discusses and highlights groundbreaking advances in the management of complex anal fistula over the past decade.

• #99 Recent advances in the diagnosis and treatment of complex anal fistula

  https://coloproctol.org/journal/view.php?doi=10.3393/ac.2024.00325.0046

  The aim of the surgical treatment of anal fistula is to achieve definitive healing through closure, obliteration, or excision of the fistula tract while avoiding fecal incontinence (FI). […] Fistulotomy remains the gold standard for treating low fistulas. However, this procedure is highly underutilized due to concerns about incontinence. This underutilization is regrettable, considering that fistulotomy is associated with the highest success rates, ranging from 95% to 100%. […] The Garg classification effectively addresses this concern. Additionally, fistulotomy is a technically straightforward procedure and is widely performed by general surgeons around the world, especially in developing countries. […] Fistulotomy has the highest cure rate among all known procedures, with an impressive 96% to 99% success rate. However, it remains highly underutilized due to surgeons’ concerns about incontinence.

• #100 Recent advances in the diagnosis and treatment of complex anal fistula

  https://www.coloproctol.org/journal/view.php?number=2057

  The aim of the surgical treatment of anal fistula is to achieve definitive healing through closure, obliteration, or excision of the fistula tract while avoiding fecal incontinence (FI). […] Fistulotomy remains the gold standard for treating low fistulas. However, this procedure is highly underutilized due to concerns about incontinence. This underutilization is regrettable, considering that fistulotomy is associated with the highest success rates, ranging from 95% to 100%. Consequently, when low fistulas suitable for fistulotomy are subjected to alternative treatments with lower success rates, unnecessary recurrences may result. […] The Garg classification effectively addresses this concern. Additionally, fistulotomy is a technically straightforward procedure and is widely performed by general surgeons around the world, especially in developing countries.

• #101 Management of Complex Anal Fistulas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4755767/

  The anal fistula plug (AFP) technique was first described in 2004, with the first case series published in 2006. The technique involves debridement of the fistula tract followed by placement of a bioprosthetic plug within the tract, securing it at the internal opening and cutting it flush with the skin at the external opening. […] The technique that has perhaps gained the most traction in recent years is the LIFT procedure. […] One of the newest technologies on the market is the use of a laser to ablate the fistula tract. […] Anal fistulas after ileal pouch-anal anastomosis are particularly complex, usually resulting from an anastomotic defect. […] There are multiple techniques available for the repair of complex anal fistulas. The best technique is not known, and the available evidence suffers from a lack of high-quality data, with very few large randomized studies.

• #102 Recent advances in the diagnosis and treatment of complex anal fistula

  https://coloproctol.org/journal/view.php?doi=10.3393/ac.2024.00325.0046

  The TROPIS procedure, a recently developed sphincter-preserving technique, stands out as the most promising of these approaches for managing complex anal fistulas. […] The LIFT procedure has been popular for over a decade as a sphincter-sparing procedure for the treatment of complex fistula. […] These device-based procedures primarily aim to manage the external aspects of fistula tracts without addressing the intersphincteric portion. Consequently, these procedures tend to have moderate success in treating simple low fistulas, which typically have minimal or no intersphincteric involvement, while they exhibit a lower success rate in managing complex high fistulas, which typically include a segment of the fistula tract within the intersphincteric plane. […] Platelet-rich plasma (PRP) has shown positive results when used as an adjunct to other procedures. […] Stem cell therapy could represent a novel therapeutic approach for complex perianal fistulas, demonstrating high efficacy in the short term.

• #103 Anal Fistula Treatment – IFFGD

  https://iffgd.org/gi-disorders/other-disorders/anal-fistulas/anal-fistula-treatment/

  The goals of treatment for a perianal fistula are the complete closure of the fistula, the elimination of sepsis (if present), the prevention of recurrence, and continence (continued ability to control bowel movements). Combined medical and surgical treatments are used to treat perianal fistulas. […] Having a multidisciplinary team which includes a gastroenterologist, radiologist, and colorectal surgeon is important. The treatment and management of perianal fistulas requires precise diagnostics to understand the disease, the correct choice of treatment option, either pharmacological or surgical, or both, as well as a monitoring plan to ensure they do not recur. There are many options and open and honest discussions between the healthcare team and the patient are extremely important. […] Most with perianal fistulas will need surgery. This is to drain the abscess causing the fistula. A colorectal surgeon will make an incision in the skin at one end of the fistula to drain the infection. This can be done either in the surgeons office with local anesthesia or in the operating room under general anesthesia. In some cases, it may take several surgeries to completely take care of the problem.

• #104 Anal Fistula – Symptoms, Diagnosis and Treatment

  https://www.samitivejhospitals.com/page/Anal-fistula-diagnosis-treatment-South-Asia

  Symptoms of anal fistula are discharge and pain in the anal area and sometimes bleeding. These are similar to symptoms experienced with hemorrhoids so an examination should be carried out by a doctor to ensure proper diagnosis and treatment. […] Anal fistulas do not heal on their own and are often chronic issues. In order to cure an anal fistula, minimize the chance of recurrence, and avoid fecal incontinence, surgery performed by a specialist is necessary. […] Surgical treatment of anal fistulas can be performed in a number of different ways, depending on the type of fistula and the symptoms experienced. The success rate, chance of recurrence, and advantages and disadvantages of each method differ accordingly; the doctor will consider all factors and select the surgical treatment most suitable for the patient.

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