Anorectal Fistula Repair

Anal fistula is a challenging condition to treat. Fistulae are classified based on their relation to the anal sphincter muscle: inter-sphincteric, trans-sphincteric, supra-sphinteric, and extra-sphincteric. Goals of repair are both to eradicate the fistula while preserving continence. The approach to operative management depends on fistula type, location, and complexity as well as surgeon and patient preference. Simple, low fistulae can often be managed with fistulotomy with excellent results. For more complex fistulae, other surgical options include ligation of intersphincteric fistula tract (LIFT), anorectal advancement flap, fistula plug, fibrin glue, long term draining seton, and cutting seton.