Anal fistula

The clinical diagnosis is usually not difficult and often characterized by the appearance of a perianal abscess, which in over 90% of cases precedes the formation of a subsequent fistula that may have a very varied course: straight or branched, deep or superficial, single or multiple. These characteristics divide fistulas into simple or complex. In addition to the clinical examination, it is necessary to perform Endoanal Ultrasound with rotating probe and, in more complex cases, MRI of the pelvic floor.

The treatment of anorectal fistulas is necessarily surgical and the technique to be adopted will depend on the "type" and the complexity of the fistula. The fistula can be removed by fistulectomy often associated with placement of trans-sphincteric draining seton, or opened by folding and flattened by fistulotomy when superficial with less involvement of sphincter muscle fibers, or closed/obliterated/coarted by use of laser, radiofrequency, biological material and more. The technique to be used should try to respect as much as possible the anorectal sphincter complex, which is always crossed by the course of the fistula. The surgery can be performed as common daily surgery with super-selective locoregional saddle anesthesia and must be performed in high volume centers to reduce the rate of complications and possibly manage them better.