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Complex anal fistula remains a challenge for colorectal surgeon

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Aim

Anal fistula is a common proctological problem to both patient and physician throughout surgical history. Several surgical and sphincter-sparing approaches have been described for the management of fistula-in-ano, aimed to minimize the recurrence and to preserve the continence. We aimed to systematically review the available studies relating to the surgical management of anal fistulas.

Material and methods

A Medline search was performed using the PubMed, Ovid, Embase, and Cochrane databases to identify articles reporting on fistula-in-ano management, aimed to find out the current techniques available, the new technologies, and their effectiveness in order to delineate a gold standard treatment algorithm.

Results

The management of low anal fistulas is usually straightforward, given that fistulotomy is quite effective, and if the fistula has been properly evaluated, continence disturbance is minimal. On the contrary, high complex fistulas are challenging, because cure and continence are directly competing priorities.

Conclusions

Conventional fistula surgery techniques have their place, but new technologies such as fibrin glues, dermal collagen injection, the anal fistula plugs, and stem cell injection offer alternative approaches whose long-term efficacy needs to be further clarified in large long-term randomized trials.

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Author contributions

All the authors contributed equally to this work. Lisi G and Ciangola I performed the PubMed research, and Cadeddu F, Salis F, and Giovanni Milito analyzed the data and wrote the paper.

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Authors and Affiliations

  1. Department of Surgery, University Hospital Tor Vergata, Rome, Italy

    G. Lisi, I. Ciangola & G. Milito

  2. Department of Surgery, San Francesco Hospital, Via Mannironi, 08020, Nuoro, Italy

    F. Cadeddu

  3. Department of Surgery, Plastic and Reconstructive Surgery, San Francesco Hospital, Nuoro, Italy

    F. Salis

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  1. F. Cadeddu
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  2. F. Salis
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  3. G. Lisi
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  4. I. Ciangola
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  5. G. Milito
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Correspondence to F. Cadeddu.

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Cadeddu, F., Salis, F., Lisi, G. et al. Complex anal fistula remains a challenge for colorectal surgeon. Int J Colorectal Dis 30, 595–603 (2015). https://doi.org/10.1007/s00384-014-2104-7

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  • DOI: https://doi.org/10.1007/s00384-014-2104-7

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