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Review
. 2020 Nov 11:13:555-567.
doi: 10.2147/CEG.S198796. eCollection 2020.

Management of Complex Cryptoglandular Anal Fistula: Challenges and Solutions

Pankaj Garg  1 , Sohail Singh Sodhi  2 , Navdeep Garg  3
Affiliations
Review

Management of Complex Cryptoglandular Anal Fistula: Challenges and Solutions

Pankaj Garg et al. Clin Exp Gastroenterol. .

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; classification; fistulotomy; incontinence; recurrence; sphincter.

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Conflict of interest statement

The authors report no conflicts of interest for this work.

Figures

Figure 1
Figure 1
A high transsphincteric fistula.
Figure 2
Figure 2
A high transsphincteric fistula with supralevator extension.
Figure 3
Figure 3
A suprasphincteric fistula.
Figure 4
Figure 4
An extrasphincteric fistula.
Figure 5
Figure 5
A 36-year-old male patient underwent surgery for a high intersphincteric fistula. Yellow arrows show the fistula tract/abscess. Left panel: preoperative MRI scans showing a high intersphincteric fistula. Middle panel: after 3 months of the first surgery, the fistula looked clinically healed with closed external opening (upper). However, the MRI scan revealed a large intersphincteric abscess (lower). The patient was operated on again. Right panel: MRI scan after 4 months of the second surgery shows complete radiological healing. The patient is doing well 18 months after the second surgery.
See this image and copyright information in PMC

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