PMID- 36911578
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230314
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 15
IP  - 3
DP  - 2023 Mar
TI  - Surgery of Simple and Complex Anal Fistulae in Adults: A Review of the Literature 
      for Optimal Surgical Outcomes.
PG  - e35888
LID - 10.7759/cureus.35888 [doi]
LID - e35888
AB  - Anal fistulas are common anorectal conditions, and surgery is the primary 
      treatment option. In the last 20 years of literature, there exist a large number 
      of surgical procedures, especially for the treatment of complex anal fistulas, as 
      they present more recurrences and continence problems than simple anal fistulas. 
      To date, there are no guidelines for choosing the best technique. We conducted a 
      recent literature review, mainly the last 20 years, based on the PubMed and 
      Google Scholar medical databases, with the goal of identifying the surgical 
      procedures with the highest success rates, lowest recurrence rates, and best 
      safety profiles. Clinical trials, retrospective studies, review articles, 
      comparative studies, recent systematic reviews, and meta-analyses for various 
      surgical techniques, as well as the latest guidelines of the American Society of 
      Colon and Rectal Surgeons, the Association of Coloproctology of Great Britain and 
      Ireland, and the German S3 guidelines on simple and complex fistulas were 
      reviewed. According to the literature, there is no recommendation for the optimal 
      surgical technique. The etiology, complexity, and many other factors affect the 
      outcome. In simple intersphincteric anal fistulas, fistulotomy is the procedure 
      of choice. In simple low transsphincteric fistulas, the patient's selection is 
      crucial in order to perform a safe fistulotomy or another sphincter-saving 
      technique. The healing rate in simple anal fistulas is higher than 95% with low 
      recurrence and without significant postoperative complications. In complex anal 
      fistulas, only sphincter-saving techniques should be used; the optimal outcomes 
      are obtained by the ligation of the intersphincteric fistulous tract (LIFT) and 
      rectal advancement flaps. Those techniques assure high healing rates of 60-90%. 
      The novel technique of the transanal opening of the intersphincteric space 
      (TROPIS) is under evaluation. The novel sphincter-saving techniques of fistula 
      laser closure (FiLac) and video-assisted anal fistula treatment (VAAFT) are safe, 
      with reported healing rates ranging from 65% to 90%. Surgeons should be familiar 
      with all sphincter-saving techniques in order to face the variability of the 
      fistulas-in-ano. Currently, there is no universally superior technique that can 
      treat all fistulas.
CI  - Copyright (c) 2023, Charalampopoulos et al.
FAU - Charalampopoulos, Anestis
AU  - Charalampopoulos A
AD  - Third Department of Surgery, "Attikon" University General Hospital/National and 
      Kapodistrian University of Athens, School of Medicine, Athens, GRC.
FAU - Papakonstantinou, Dimitrios
AU  - Papakonstantinou D
AD  - Third Department of Surgery, "Attikon" University General Hospital/National and 
      Kapodistrian University of Athens, School of Medicine, Athens, GRC.
FAU - Bagias, George
AU  - Bagias G
AD  - Third Department of Surgery, "Attikon" University General Hospital/National and 
      Kapodistrian University of Athens, School of Medicine, Athens, GRC.
FAU - Nastos, Konstantinos
AU  - Nastos K
AD  - Third Department of Surgery, "Attikon" University General Hospital/National and 
      Kapodistrian University of Athens, School of Medicine, Athens, GRC.
FAU - Perdikaris, Markos
AU  - Perdikaris M
AD  - Third Department of Surgery, "Attikon" University General Hospital/National and 
      Kapodistrian University of Athens, School of Medicine, Athens, GRC.
FAU - Papagrigoriadis, Savvas
AU  - Papagrigoriadis S
AD  - Rectal and Pelvic Surgery, Metropolitan General Hospital Athens, Athens, GRC.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20230308
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC9993441
OTO - NOTNLM
OT  - anal fistula
OT  - complex anal fistula
OT  - endorectal advancement flap
OT  - fistula-in-ano
OT  - fistulectomy
OT  - fistulotomy
OT  - laser fistulotomy
OT  - simple fistula
OT  - surgery
OT  - video-assisted anal fistula treatment
COIS- The authors have declared that no competing interests exist.
EDAT- 2023/03/14 06:00
MHDA- 2023/03/14 06:01
PMCR- 2023/03/08
CRDT- 2023/03/13 04:28
PHST- 2023/03/08 00:00 [accepted]
PHST- 2023/03/13 04:28 [entrez]
PHST- 2023/03/14 06:00 [pubmed]
PHST- 2023/03/14 06:01 [medline]
PHST- 2023/03/08 00:00 [pmc-release]
AID - 10.7759/cureus.35888 [doi]
PST - epublish
SO  - Cureus. 2023 Mar 8;15(3):e35888. doi: 10.7759/cureus.35888. eCollection 2023 Mar.