Abstract
Introduction: Fistula-in-ano has constantly examined the patience of even the best surgeons. There has never been agreement on the best surgeries for the fistula-in-ano, especially those with cryptoglandular origin. Recent classic surgeries such as ligation of intersphincteric fistula tract (LIFT) and video-assisted anal fistula treatment (VAAFT) have been successful but require more research and longer follow-up period to confirm them. Developments in flaps and setons are still hugely utilized. Setons are used as a cutting seton or as a draining seton. Cutting seton and fistulotomy have excellent success rates however we should take into consideration the complications such as incontinence associated with it. Fistulectomy with primary sphincter reconstruction sounds to be a very hopeful surgery, however long-term findings are still awaited. Most of the research have small sample size, and there is no equivalent comparison between the different kind of surgeries to give a definitive result. Cryptoglandular infection is considered to be responsible for about more than ninety percent of anal fistulas. There has been no agreement on surgical options for managing it. The available options have not produced significant results; so, there is a need to find new options. Recurrence and incontinence are the 2 main paradoxical factors which a surgeon fears and drives them to tilt on one side or the other. The recently developed techniques aim to be less invasive with less complications, but at the cost of increased recurrence rate. Aim of work: In this review, we will discuss the types and management of Anal fistula
Methodology: We did a systematic search for the types and management of Anal fistula using PubMed search engine (http://www. ncbi. nlm. nih. gov/) and Google Scholar search engine (https://scholar. google. com). All relevant studies were retrieved and discussed. We only included full articles. Conclusions: Recently, new surgeries have been developed to the available list of surgeries for anal fistula. This has only added to the number of surgeries existing and could potentially confuse the surgeons further with the best choice. Advancement flaps and seton placement have been widely spread and used and are still being implemented as a first line of treat for anal fistula. But, recently new technique such as LIFT have been used. The anal fistula plug has success rates like advancement flap and has not been able to be proven very popular. VAAFT and autologous adipose-derived stem cells are recently developed techniques with not much research on their success rates. Fibrin glue has moderate result with simple low fistula, but poor results with high or complex anal fistula. Cutting seton and fistulotomy have good success rate, however surgeons have to consider the complications such as incontinence. Primary suturing after fistulectomy for transsphincteric fistula appears to take care of this incontinence and is something to look out for in the future. Recurrence after draining an anorectal abscess could be lowered, if fistulotomy is done primarily by experienced surgeons. There are limitations to the available studies such as small size, and there are no randomized trials available, that compare the success of various procedures against equivalent types of fistula. In the present, there is no evidence to recommend or go against any single procedure. There is definitely no golden surgery as for anal fistula. The surgeon has to decide the procedure based on his past experience and the type of fistula he/she is dealing with. There is defintely a lot of need for more research.