Management of anal fistula

Abstract

Anal fistula is a chronic condition that may present de novo or after an acute anorectal abscess. Management goal is to eradicate the fistula and prevent recurrence while maintaining continence. Simple or low anal fistulas are best treated with a primary fistulotomy with excellent healing rates and functional outcomes. The management of complex anal fistulas is more difficult and controversial. No proved surgical procedure has gained acceptable as the gold standard yet. Over the last two decades, many sphincter-preserving procedures were introduced with the common goal of minimizing the injury to the anal sphincter and preserving the optimal function. Recently, a number of new techniques were developed and proposed such as ligation of intersphincteric fistula tract (LIFT); endorectal advancement flap (EAF); video-assisted anal fistula treatment (VAAFT); fistula tract laser closure (FiLAC); fibrin sealants and anal fistula plug (AFP), and adipose-derived stem cells (ASC). There are multiple techniques available for complex anal fistula repair. The best technique is not known yet, and the evidence available suffers from a lack of high-quality data and presents with very few large randomized studies. This review summarizes the management of anal fistulas and the current techniques available. It describes some new technologies, too. Scr