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Anorectal Fistula

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Book cover Contemporary Coloproctology

Abstract

It is surprising that none of the quotes about the early use of the term fistula come from John of Arderne (1307–1392), whose classic work on the treatment of anal fistula is still in print, and who predates them all. It is possible that more has been written by surgeons about anorectal abscess and fistula than any other condition over the expanse of time and world geography [1–4]. Hippocrates (b. ∼460 BC) of course described the seton suture and Sushruta (b. ∼800 BC) described both fistulotomy and fistulectomy as well as the use of cauterizing chemicals in the fistula track. These treatments are still in common use (see below). This ongoing concern is a testament both to the prevalent nature of these disorders and the difficulty they present to the surgeon in basic decision making. The reasons for these difficult decisions are obvious. On the one hand, it is necessary to resolve sepsis and symptoms associated with it, principally pain, and yet the procedures that one employs must also preserve function in the anal canal, that is, prevent incontinence. Although surgeons have been treating anal fistulas for centuries, evidence supporting the effectiveness of these treatments is poor and scientific study scant (Box 4.1).

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Author information

Authors and Affiliations

  1. Department of Surgery, Northern General Hospital, Herries Rd., Sheffield, S5 7AU, UK

    Rick Nelson FRCS

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  1. Rick Nelson FRCS
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Correspondence to Rick Nelson FRCS .

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Editors and Affiliations

  1. Sheffield Teaching Hospitals NHS Foundat, Sheffield, S5 7AU, United Kingdom

    Steven R. Brown

  2. Hull Royal Infirmary, Hull, United Kingdom

    John E. Hartley

  3. Manchester Royal Infirmary, Manchester, M13 9WL, United Kingdom

    Jim Hill

  4. Hope Hospital, Manchester, United Kingdom

    Nigel Scott

  5. New Cross Hospital, Royal Wolverhampton Hospital Trust, Wolverhampton, WV10 0QP, United Kingdom

    J. Graham Williams

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Nelson, R. (2012). Anorectal Fistula. In: Brown, S., Hartley, J., Hill, J., Scott, N., Williams, J. (eds) Contemporary Coloproctology. Springer, London. https://doi.org/10.1007/978-0-85729-889-8_4

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  • DOI: https://doi.org/10.1007/978-0-85729-889-8_4

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