Complex anal fistula with synovial cyst at the ischial tuberosity is a very rare condition. The key point in the operation is to protect the anal sphincter and completely peel off the cyst. Here, we report a successful case of closing the internal opening with the advancement flap technique and completely stripping the cyst (Figs. 1, 2, 3, 4, 5).Chang-Fang Xiao and Ya-Qing Ding contributed equally to this work and are co-first authors.
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