Endosonography with a high-frequency transducer is superior to digital examination for the preoperative classification of fistula in ano. While MR imaging remains superior in all respects, endosonography is a viable alternative for identification of the internal opening.

Although stapled hemorrhoidectomy is less painful in the short term, this does not lead to a significantly earlier return to work, and some patients develop new symptoms at long-term follow-up.

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The success rate of the LST for complex fistula in ano falls over time. Counselling before seton removal should emphasize that, although most patients do not require sphincter division and some are cured by this technique, many patients develop further sepsis that usually requires surgery.