Management of Complex Cryptoglandular Anal Fistula: Challenges and Solutions

Abstract

Anal fistulae can be a very difficult disease to manage. The management of complex fistulae is even more challenging. The risk to the fecal continence mechanism due to damage to the anal sphincters and refractoriness to the treatment (high recurrence rate) pose the two biggest challenges in the management of this disease. Apart from these, there are several other challenges in the treatment of complex fistulae. The intriguing and uphill task is that satisfactory solutions to most of these challenges are still not known, and there is hardly any consensus on whatever treatment solutions are available. To summarize, there is no gold-standard treatment available for treating complex anal fistulae, and the search for a satisfactory treatment option is still on. In this review, the endeavor has been to discuss and highlight recent path-breaking updates in the management of complex anal fistulae.

Keywords:

• anal fistula
• recurrence
• incontinence
• classification
• fistulotomy
• sphincter

Abbreviations

MRI, magnetic resonance imaging; TRUS, transrectal ultrasound; TROPIS, transanal opening of intersphincteric space; LIFT, ligation of intersphincteric fistula tract; ISTAC, intersphincteric tract is an abscess in a closed space; DRAPED, draining all pus and ensuring continuous drainage.

Author Contributions

All authors (PG, SSS, and NG) made a significant contribution to the work reported, whether in conception, study design, execution, acquisition of data, analysis, and interpretation, took part in drafting, revising, or critically reviewing the article, gave final approval to the version to be published, have agreed on the journal to which the article has been submitted, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest for this work.

Additional information

Funding

The authors declare that no funding was received.