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Evaluation and management of perianal abscess and anal fistula: SICCR position statement

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Abstract

Perianal sepsis is a common condition ranging from acute abscess to chronic anal fistula. In most cases, the source is considered to be a non-specific cryptoglandular infection starting from the intersphincteric space. Surgery is the main treatment and several procedures have been developed, but the risks of recurrence and of impairment of continence still seem to be an unresolved issue. This statement reviews the pertinent literature and provides evidence-based recommendations to improve individualized management of patients.

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References

  1. Eisenhammer S (1954) Advances in anorectal surgery with special reference to ambulatory treatment. S Afr Med J 28:264

    CAS  PubMed  Google Scholar 

  2. Goligher JC, Ellis M, Pissidis AG (1967) A critique of anal glandular infection in the aetiology and treatment of idiopathic anorectal abscesses and fistulas. Br J Surg 54:977–983

    CAS  PubMed  Google Scholar 

  3. Lunniss PJ, Phillips RKS (1994) Surgical assessment of acute anorectal sepsis is a better predictor of fistula than microbiological analysis. Br J Surg 81:368–369

    CAS  PubMed  Google Scholar 

  4. Parks AG (1961) Pathogenesis and treatment of fistula-in-ano. Br Med J 18:463–469

    Google Scholar 

  5. Williams JG, Farrands PA, Williams AB et al (2007) The treatment of anal fistula: ACPGBI position statement. Colorectal Dis 9:18–50

    PubMed  Google Scholar 

  6. Lillius HG (1968) An investigation on human foetal anal ducts and intramuscular glands: a clinical study of 150 patients. Acta Chir Scan 383:7–88

    Google Scholar 

  7. Abeysuriya V, Salgado LS, Samarasekera DN (2010) The distribution of the anal glands and the variable regional occurrence of fistula-in-ano: is there a relationship? Tech Coloproctol 14:317–321

    CAS  PubMed  Google Scholar 

  8. Marks CG, Ritchie JK, Lockhart-Mummery HE (1981) Anal fistulas in Crohn’s disease. Br J Surg 68:525–527

    CAS  PubMed  Google Scholar 

  9. Culp CE (1983) Chronic hidradenitis of the anal canal: a surgical skin disease. Dis Colon Rectum 26:669–676

    CAS  PubMed  Google Scholar 

  10. Shukla HS, Gupta SC, Singh G, Singh PA (1988) Tubercular fistula in ano. Br J Surg 75:38–39

    CAS  PubMed  Google Scholar 

  11. Eisenhammer S (1956) The internal anal sphincter and the anorectal abscess. Surg Gynecol Obstet 103:501–506

    CAS  PubMed  Google Scholar 

  12. Parks AG, Gordon PH, Hardcastle JD (1976) A classification of fistula-in-ano. Br J Surg 63:1–12

    CAS  PubMed  Google Scholar 

  13. Sneider EB, Maykel JA (2013) Anal abscess and fistula. Gastroenterol Clin N Am 42:773–784

    Google Scholar 

  14. Zanotti C, Martinez-Puente C, Pascual I, Pascual M, Herreros D, Garcia-Olmo D (2007) An assessment of the incidence of fistula-in-ano in four countries of the European union. Int J Color Dis 22:1459–1462

    Google Scholar 

  15. Sainio P (1984) Fistula-in-ano in a defined population. Incidence and epidemiological aspects. Ann Chir Gynaecol 73:219–224

    CAS  PubMed  Google Scholar 

  16. Hamalainen KP, Sainio AP (1998) Incidence of fistulas after drainage of acute anorectal abscesses. Dis Colon Rectum 41:1357–1361

    CAS  PubMed  Google Scholar 

  17. Fazio VW (1987) Complex anal fistulae. Gastroenterol Clin North Am 16:93–114

    CAS  PubMed  Google Scholar 

  18. Luniss PJ, Sheffield JP, Talbot IC, Thomson JP, Phillips RK (1995) Persistence of idiopathic anal fistula may be related to epithlialization. Br J Surg 82:32–33

    Google Scholar 

  19. van Koperen PJ, Ten Kate FJ, Bemelman WA, Slors JF (2010) Histological identification of epithelium in perianal fistulae: a prospective study. Colorectal Dis 12(9):891–895

    PubMed  Google Scholar 

  20. Mitalas LE, van Onkelen RS, Monkhorst K, Zimmerman DD, Gosselink MP, Schouten WR (2012) Identification of epithelization in high transsphincteric fistulas. Tech Coloproctol 16(2):113–117

    CAS  PubMed  PubMed Central  Google Scholar 

  21. Göttgens KW, Smeets RR, Stassen LP, Beets G, Breukink SO (2015) Systematic review and meta-analysis of surgical interventions for high cryptoglandular perianal fistula. Int J Colorectal Dis 30:583–593

    PubMed  Google Scholar 

  22. Amato A, Bottini C, De Nardi P, Giamundo P, Lauretta A, Realis Luc A, Tegon G, Nicholls RJ (2015) Evaluation and management of perianal abscess and anal fistula: a consensus statement developed by the Italian society of colorectal surgery (SICCR). Tech Coloprctol 19:595–606

    CAS  Google Scholar 

  23. Guyatt G, Gutterman D, Baumann MH et al (2006) Grading strength of recommendations and quality of evidence in clinical guidelines: report from an American college of chest physicians task force. Chest 129:174–181

    PubMed  Google Scholar 

  24. Parks AG, Thompson JPS (1973) Intersphinteric abscess. Br Med J 2:537–539

    CAS  PubMed  PubMed Central  Google Scholar 

  25. Goldberg SM, Gordon PH, Nivatvongs S (1980) Essential of anorectal surgery. JB Lippincott, Philadelphia, pp 100–127

    Google Scholar 

  26. Nelson J, Billingham R (2007) Pilonidal disease and hidradenitis suppurativa. In: Wollf BG, Fleshman JW, Beck DE, et al. (eds) The ASCRS textbook of colon and rectal surgery. Springer, New York, pp 228–235

    Google Scholar 

  27. Goodsall DH, Miles WE (1982) Anorectal fistula. Dis Colon Rectum 25:262–278

    Google Scholar 

  28. Cirocco WC, Reilly JC (1992) Challenging the predictive accuracy of Goodsall’s rule for anal fistulas. Dis Colon Rectum 35:537–542

    CAS  PubMed  Google Scholar 

  29. Gunawardhana PA, Keen DI (2001) Comparison of hydrogen peroxide instillation with Goodsall’s rule for fistula-in-ano. Aust NZ J Surg 71:472–474

    CAS  Google Scholar 

  30. Law PJ, Talbot RW, Bartram CI, Northover JMA (1989) Anal endosonography in the evaluation of perianal sepsis and fistula in ano. Br J Surg 76:752–755

    CAS  PubMed  Google Scholar 

  31. Spencer JA, Chapple K, Wilson D, Ward J, Windsor AC, Ambrose NS (1998) Outcome after surgery for perianal fistula: predictive value of MR imaging. Am J Roentgenol 171:403–406

    CAS  Google Scholar 

  32. Morris J, Spencer JA, Ambrose NS (2000) MR Imaging classification of perianal fistulas and its implications for patient management. Radiographics 20:623–635

    CAS  PubMed  Google Scholar 

  33. Beets-Tan RG, Beets GL, van der Hoop AG et al (2001) Preoperative MR imaging of anal fistulas: does it really help the surgeon? Radiology 218:75–84

    CAS  PubMed  Google Scholar 

  34. Gustafsson UM, Kahvecioglu B, Astrom G et al (2001) Endoanal ultrasound or magnetic resonance imaging for preoperative assessment of anal fistula: a comparative study. Colorectal Dis 3:189–197

    CAS  PubMed  Google Scholar 

  35. Lengyel AJ, Hurst NG, Williams JG (2002) Pre-operative assessment of anal fistulas using endoanal ultrasound. Colorectal Dis 4:436–440

    CAS  PubMed  Google Scholar 

  36. Kuijpers HC, Schulpen T (1985) Fistulography for fistula-in-ano: is it useful? Dis Colon Rectum 28:103–104

    CAS  PubMed  Google Scholar 

  37. Weisman RI, Orsay CP, Pearl RK et al (1991) The role of fistulography in fistula-in-ano: report of 5 cases. Dis Colon Rectum 34:181–184

    CAS  PubMed  Google Scholar 

  38. Buchanan GN, Halligan S, Bartram CI et al (2004) Clinical examination, endosonography, and MR imaging in preoperative assessment of fistula in ano: comparison with outcome-based reference standard. Radiology 233(3):674–681

    PubMed  Google Scholar 

  39. Piloni V, Chiavarini M, Fabbroni L et al (2016) Practical MR imaging of anal fistula disease: how we do it. Int J Coll Res Int Med Pub Health 8(9):561–571

    Google Scholar 

  40. Cheong DMO, Nogueras JJ, Wexner SD, Jagelman DG (1993) Anal endosonography for recurrent fistulas: image enhancement with hydrogen peroxide. Dis Colon Rectum 36:1158–1160

    CAS  PubMed  Google Scholar 

  41. Ratto C, Gentile E, Merico M et al (2000) How can the assessment of fistula-in-ano be improved? Dis Colon Rectum 43:1375–1382

    CAS  PubMed  Google Scholar 

  42. West RL, Zimmerman DD, Dwarkasing S et al (2003) Prospective comparison of hydrogen peroxide-enhanced three-dimensional endoanal ultrasonography and endoanal magnetic resonance imaging of perianal fistulas. Dis Colon Rectum 46:1407–1415

    CAS  PubMed  Google Scholar 

  43. Santoro GA, Ratto C, Di Falco G (2004) Three-dimensional reconstructions improve the accuracy of endoanal ultrasonography in the identification of internal openings of anal fistulas. Colorect Dis 6(suppl):214

    Google Scholar 

  44. Sun Y, Cui LG, Liu JB et al (2018) Utility of 360° real-time endoanal sonography for evaluation of perianal fistulas. J Ultrasound Med 37:93–98

    PubMed  Google Scholar 

  45. Cho DY (1999) Endosonographic criteria for an internal opening of fistula in ano. Dis Colon Rectum 42:515–518

    CAS  PubMed  Google Scholar 

  46. Stewart LK, McGee J, Wilson SR (2001) Transperineal and transvaginal sonography of perianal inflammatory disease. AJR Am J Roentgenol 177:627–632

    CAS  PubMed  Google Scholar 

  47. Wedemeyer J, Kirchhofft T, Sellge G et al (2004) Transcutaneous perianal sonography: a sensitive method for the detection of perianal inflammatory lesions in Crohn’s disease. World J Gastroenterol 10:2859–2863

    PubMed  PubMed Central  Google Scholar 

  48. de Souza NM, Hall AS, Puni R et al (1996) High resolution magnetic resonance imaging of the anal sphincter using a dedicated endoanal coil. Comparison of magnetic resonance imaging with surgical findings. Dis Colon Rectum 39:926–934

    Google Scholar 

  49. deSouza NM, Gilderdale DJ (1998) Coutts GA (1998) MRI of fistula-in-ano: a comparison of endoanal coil with external phased array coil techniques. J Comp Assist Tomogr 22:357–363

    CAS  Google Scholar 

  50. Spencer JA, Ward J, Beckingham IJ, Adams C, Ambrose NS (1996) Dynamic contrast-enhanced MR imaging of perianal fistulas. Am J Roentgenol 167:735–741

    CAS  Google Scholar 

  51. Schafer O, Lohrmann C, Langer M (2003) (2003) Digital subtraction MR fistulography: new diagnostic tool for the detection of fistula in ano. AJR 181:1611–1613

    Google Scholar 

  52. Brook RH, Chassin MR, Fink A et al (1986) A method for the detailed assessment of the appropriateness of medical technologies. Int J Tech Ass Health Care 2:53–63

    CAS  Google Scholar 

  53. Siddiqui MR, Ashrafian H, Tozer P et al (2012) A diagnostic accuracy meta-analysis of endoanal ultrasound and MRI for perianal fistula assessment. Dis Colon Rectum 55(5):576–585

    PubMed  Google Scholar 

  54. Ommer A, Herold A, Berg E et al (2017) German S3 guidelines: anal abscess and fistula (second revised version. Langenbecks Arch Surg. 402(2):191–201

    PubMed  Google Scholar 

  55. Pescatori M, Ayabaca S, Caputo D (2004) Can anal manometry predict anal incontinence after fistulectomy in males? Colorectal Dis 6:97–102

    CAS  PubMed  Google Scholar 

  56. Sainio P (1985) A manometric study of anorectal function after surgery for anal fistula, with special reference to incontinence. Acta Chir Scand 151:695–700

    CAS  PubMed  Google Scholar 

  57. Pescatori M, Maria G, Anastasio G, Rinallo L (1989) Anal manometry improves the outcome of surgery for fistula-in-ano. Dis Colon Rectum 32:588–592

    CAS  PubMed  Google Scholar 

  58. Luchtefeld MA (2001) Anorectal abscess and fistula-in-ano. Clin Colon Rectal Surg 14:221–231

    Google Scholar 

  59. Senéjoux A, Siproudhis L (2013) «B.A.-BA SANS EBM…» du traitement des abcès et des fistules anales: 10 questions basiques (… ou à se poser fréquemment) Dis Colon Rectum 7:205–208

    Google Scholar 

  60. Buyukasik Y, Ozcebe OI, Sayinalp N et al (1998) Perianal infections in patients with leukemia: importance of the course of neutrophil count. Dis Colon Rectum 41:81–85

    CAS  PubMed  Google Scholar 

  61. Cohen JS, Paz IB, O’Donnell MR, Ellenhorn JD (1996) Treatment of perianal infection following bone marrow transplantation. Dis Colon Rectum 39:981–985

    CAS  PubMed  Google Scholar 

  62. Wilson W, Taubert KA, Gewitz T et al (2007) Prevention of infective endocarditis. guidelines from the American heart association: a guideline from the American heart association rheumatic fever, endocarditis, and kawasaki disease committee, council on cardiovascular disease in the young, and the council on clinical cardiology, council on cardiovascular surgery and anesthesia, and the quality of care and outcomes research interdisciplinary working group. Circulation 16:1736–1754

    Google Scholar 

  63. Ghahramani L, Mohammad RM, Arasteh P, Vahid Hosseini S, Izadpanah A, Bananzadeh AM, Ahmadbegi M, Hooshanginejad Z (2017) Antibiotic therapy for prevention of fistula in-ano after incision and drainage of simple perianal abscess: a randomized single blind clinical trial. Surgery 5:1017–1025

    Google Scholar 

  64. Ramanujam PS, Prasad ML, Abcarian H, Tan AB (1984) Perianal abscess and fistulas. Dis Colon Rectum 27:593–597

    CAS  PubMed  Google Scholar 

  65. Matthew JF (2005) Anal abscesses and fistulas. ANZ J Surg 75:64–72

    Google Scholar 

  66. Onaca N, Hirshberg A, Adar R (2001) Early reoperation for perirectal abscess: a preventable complication. Dis Colon Rec-tum 44:1469–1473

    CAS  Google Scholar 

  67. Held D, Khubchandani I, Sheets J, Stasik J, Rosen L, Riether R (1986) Management of anorectal horseshoe abscess and fistula. Dis Colon Rectum 29:793–797

    CAS  PubMed  Google Scholar 

  68. Malik AI, Nelson RL, Tou S (2010) Incision and drainage of perianal abscess with or without treatment of anal fistula. Cochrane Database Syst Rev 7:CD006827.

  69. Quah HM, Tang CL, Eu KW, Chan SY, Samuel M (2005) Meta-analysis of randomized clinical trials comparing drainage alone vs primary sphincter-cutting procedures for anorectal abscess-fistula. Int J Colorectal Dis 30:1–8

    Google Scholar 

  70. Tan KK, Liu X, Tsang CB, Koh DC (2012) Identification of the internal anal opening and seton placement improves the out-come of deep postanal space abcess. Colorectal Dis 15:598–601

    Google Scholar 

  71. Schouten WR, van Vroonhoven TJ (1991) Treatment of anorectal abscess with or without primary fistulectomy. results of a prospective randomized trial. Dis Colon Rectum 34:60–63

    CAS  PubMed  Google Scholar 

  72. Cox SW, Senagore AJ, Luchtefeld MA, Mazier WP (1997) Outcome after incision and drainage with fistulotomy for ischiorectal abscess. Am Surg 63:686–689

    CAS  PubMed  Google Scholar 

  73. Davies M, Harris D, Lohana P et al (2008) The surgical management of fistula-in-ano in a specialist colorectal unit. Int J Colorectal Dis 23:833–838

    CAS  PubMed  Google Scholar 

  74. Ho KS, Tsang C, Seow-Choen F, Tang CL, Heah SM, Eu KW (2001) Prospective randomized trial comparing ayurvedic cutting seton and fistulotomy for low fistula-in-ano. Tech Coloproctol 5:137–141

    CAS  PubMed  Google Scholar 

  75. Westerterp M, Volkers NA, Poolman RW, van Tets WF (2003) Anal fistulotomy between Scylla and Charybdis. Colorectal Dis 5:549–551

    CAS  PubMed  Google Scholar 

  76. J Jordan, JV Roig, García-Armengol J, García -Granero E, Solana A, Lledo S, (2010) Risk factors for recurrence and incontinence after anal fistula surgery Colorectal Dis 12:254–260

    PubMed  Google Scholar 

  77. Garcia-Aguilar J, Belmonte C, Wong WD, Goldberg SM, Madoff RD (1996) Anal fistula surgery. Factors associated with recurrence and incontinence. Dis Colon Rectum 39:723–729

    CAS  PubMed  Google Scholar 

  78. Chang SC, Lin JK (2003) Change in anal continence after surgery for intersphincteral anal fistula: a functional and manometric study. Int J Colorectal Dis 18:111–115

    PubMed  Google Scholar 

  79. Cavanaugh M, Hyman N, Osler T (2002) Fecal incontinence severity index after fistulotomy: a predictor of quality of life. Dis Colon Rectum 45:349–353

    PubMed  Google Scholar 

  80. Buchanan GN, Williams AB, Bartram CI, Halligan S, Nicholls RJ, Cohen CR (2003) Potential clinical implications of direction of a trans-sphincteric anal fistula track. Br J Surg 90:1250–1255

    CAS  PubMed  Google Scholar 

  81. Gupta PJ (2003) Radiosurgical fistulotomy; an alternative to conventional procedure in fistula in ano. Curr Surg 60:524–528

    PubMed  Google Scholar 

  82. Gupta PJ (2003) Radio frequency ‘‘sutureless’’ fistulotomy- a new way of treating fistula in anus. World J Gastroenterol 9:1082–1085

    PubMed  PubMed Central  Google Scholar 

  83. Filingeri V, Gravante G, Baldessari E, Casciani CU (2004) Radiofrequency fistulectomy vs. diathermic fistulotomy for submucosal fistulas: a randomized trial. Eur Rev Med Pharmacol Sci 8:111–116

    CAS  PubMed  Google Scholar 

  84. Jacob TJ, Perakath B, Keighley MR (2010) Surgical intervention for anorectal fistula. Cochrane Database Syst Rev 12:CD006319.

  85. Ho YH, Tan M, Leong AF, Seow-Choen F (1998) Marsupialization of fistulotomy wounds improves healing: a randomized controlled trial. Br J Surg 85:105–107

    CAS  PubMed  Google Scholar 

  86. Pescatori M, Ayabaca SM, Cafaro D, Iannello A, Magrini S (2006) Marsupialization of fistulotomy and fistulectomy wounds improves healing and decreases bleeding: a randomized controlled trial. Colorectal Dis 8:11–14

    CAS  PubMed  Google Scholar 

  87. Lentner A, Wienert V (1996) Long-term, indwelling setons for low transsphincteric and intersphincteric anal fistulas. Experience with 108 cases. Dis Colon Rectum 39:1097–1101

    CAS  PubMed  Google Scholar 

  88. Indian Council of Medical Research (1991) Multicentric randomized controlled clinical trial of Kshaarasootra (Ayurvedic medicated thread) in the management of fistula-in-ano. Indian J Med Res 94:177–185

    Google Scholar 

  89. Kronborg O (1985) To lay open or excise a fistula-in-ano: a randomized trial. Br J Surg 72:970

    CAS  PubMed  Google Scholar 

  90. Belmonte Montes C, Ruiz Galindo GH, Montes Villalobos JL, Decanini Teràn C (1999) Fistulotomy vs. fistulectomy. Ultrasonographic evaluation of lesion of the anal sphincter function. Rev Gastroenterol Mex 64:167–170

    CAS  PubMed  Google Scholar 

  91. Steele SR, Kumar R, Feingold DL, Rafferty JL, Buie WD (2011) Practice parameters for the management of perianal abscess and fistula-in-ano. Dis Colon Rectum 54:1465–1474

    PubMed  Google Scholar 

  92. Swinscoe MT, Ventakasubramaniam AK, Jayne DG (2005) Fibrin glue for fistula-in-ano: the evidence reviewed. Tech Coloproctol 9:89–94

    CAS  PubMed  Google Scholar 

  93. Lindsey I, Smilgin-Humphreys MM, Cunningham C, Mortensen NJ, George BD (2002) A randomized, controlled trial of fibrin glue vs. conventional treatment for anal fistula. Dis Colon Rectum 45:1608–1615

    PubMed  Google Scholar 

  94. Ozuner G, Hull TL, Cartmill J, Fazio VW (1996) Long-term analysis of the use of transanal rectal advancement flaps for complicated anorectal/vaginal fistulas. Dis Colon Rectum 39:10–14

    CAS  PubMed  Google Scholar 

  95. Ortiiz H, Marzo M, de Miguel M, Ciga MA, Oteiza F, Armendariz P (2008) Length of follow-up after fistulotomy and fistulectomy associated with endorectal advancement flap repair for fistula in ano. Br J Surg 95:484–487

    Google Scholar 

  96. Mizrahi N, Wexner SD, Zmora O et al (2002) Endorectal advancement flap: are there predictors of failure? Dis Colon Rectum 45:1616–1621

    PubMed  Google Scholar 

  97. Abbas MA, Lemus-Rangel R, Hamadani A (2008) Long-term outcome of endorectal advancement flap for complex anorectal fistulae. Am Surg 74:921–924

    PubMed  Google Scholar 

  98. Dubsky PC, Stift A, Friedl J, Teleky B, Herbst F (2008) Endorectal advancement flaps in the treatment of high anal fistula of cryptoglandular origin: full-thickness vs. mucosal-rectum flaps. Dis Colon Rectum 51:852–857

    PubMed  Google Scholar 

  99. Balciscueta Z et al. (2017) Rectal advancement flap for the treatment of complex cryptoglandular anal fistulas: a systematic review and meta-analysis. Int J Colorectal Dis May 32(5), 599–609.

    PubMed  Google Scholar 

  100. Ellis CN (2007) Clark S (2007) Effect of tobacco smoking on advancement flap repair of complex anal fistula. Dis Colon Rectum. 50(4):459–463

    PubMed  Google Scholar 

  101. Schwandner O (2011) Obesity is a negative predictor of success after surgery for complex anal fistula. BMC Gastroenterol 11:61

    CAS  PubMed  PubMed Central  Google Scholar 

  102. Gustafsson UM, Graf W (2006) Randomized clinical trial of local gentamicin-collagen treatment in advancement flap repair for anal fistula. Br J Surg 93(10):1202–1207

    CAS  PubMed  Google Scholar 

  103. van Okelen RS, Gosselink MP, Thijsse S, Schouten WR (2014) Predictors of outcome after transanal advancement flap repair for high transsphincteric fistulas. Dis Colon Rectum 57:1007–1011

    Google Scholar 

  104. Ellis CN, Clark S (2006) Fibrin glue as an adjunct to flap repair of anal fistulas: a randomized, controlled study. Dis Colon Rectum 49:1736–1740

    PubMed  Google Scholar 

  105. Sugrue J, Mantilla N, Abcarian A, Kochar K, Marecik S, Chaudhry V, Mellgren A, Nordenstam J (2017) Sphincter-sparing anal fistula repair: Are we getting better? Dis Colon Rectum 60(10):1071–1077

    PubMed  Google Scholar 

  106. Lin H, Jin Z, Zhu Y, Diao M, Hu W (2018) Anal fistula plug vs rectal advancement flap for the treatment of complex cryptoglandular analfistulas: a system review and meta-analysis of studies with long-term follow-up. Colorectal Dis doi: 10.1111/codi.14504. Epub 2018 Dec 21.

    PubMed  Google Scholar 

  107. N Uribe Millań M Minguez M et al. (2007) Clinical and manometric results of endorectal advancement flaps for complex anal fistula Int J Colorectal Dis 22:259–264.

    PubMed  Google Scholar 

  108. Schouten WR, Zimmerman DD, Briel JW (1999) Transanal advancement flap repair of transsphincteric fistulas. Dis Colon Rectum 42:1419–1422

    CAS  PubMed  Google Scholar 

  109. Athanasiadis S, Helmes C, Yazigi R, Kohler A (2004) The direct closure of the internal fistula opening without advancement flap for transsphincteric fistulas-in-ano. Dis Colon Rectum 47:1174–1180

    PubMed  Google Scholar 

  110. Perez F, Arroyo A, Serrano P et al (2006) Randomized clinical and manometric study of advancement flap versus fistulotomy with sphincter reconstruction in the management of complex fistula-in-ano. Am J Surg 192:34–40

    PubMed  Google Scholar 

  111. Van Koperen PJ, Wind J, Bemelman WA, Bakx R, Reitsma JB, Slors JF (2008) Long-term functional outcome and risk factors for recurrence after surgical treatment for low and high perianal fistulas of cryptoglandular origin. Dis Colon Rectum 51:1475–1481

    PubMed  Google Scholar 

  112. Vasilevsky CA, Gordon PH (2007) Benign anorectal: abscess and fistula. In: Wolff BG, Fleshman JW, Beck DE, Pemberton JH, Wexner SD (eds) The ASCRS textbook of colon and rectal surgery. Springer, New York, pp 192–214

    Google Scholar 

  113. Tyler KM, Aarons CB, Sentovich SM (2007) Successful sphincter-sparing surgery for all anal fistulas. Dis Colon Rectum 50:1535–1539

    PubMed  Google Scholar 

  114. Van der Hagen SJ, Baeten CG, Soeters PB, van Gemert WG (2006) Long-term outcome following mucosal advancement flap for high perianal fistulas and fistulotomy for low perianal fistulas: recurrent perianal fistulas—failure of treatment or recurrent patient disease? Int J Colorectal Dis 21:784–790

    PubMed  Google Scholar 

  115. Golub RW, Wise WE, Kerner BA, Khanduja KS, Aguilar PS (1997) Endorectal mucosal advancement flap: the preferred method for complex cryptoglandular fistula-in-ano. J Gastrointest Surg 1:487–491

    CAS  PubMed  Google Scholar 

  116. Rojanasakul A, Pattanaarun J, Sahakitrungruang C, Tantiphlachiva K (2007) Total anal sphincter saving technique for fistula-in-ano; the ligation of intersphincteric fistula tract. J Med Assoc Thai 90:581–586

    PubMed  Google Scholar 

  117. Bleier JI, Moloo H, Goldberg SM (2010) Ligation of the intersphincteric fistula tract: an effective new technique for complex fistulas. Dis Colon Rectum 53:43–46

    PubMed  Google Scholar 

  118. Shanwani A, Nor AM, Amri N (2010) Ligation of the intersphincteric fistula tract (LIFT): a sphincter-saving technique for fistula-in-ano. Dis Colon Rectum 53:39–42

    CAS  PubMed  Google Scholar 

  119. Alasari S, Kim NK (2014) Overview of anal fistula and systematic review of ligation of the intersphincteric fistula tract (LIFT). Tech Coloproctol 18:13–22

    CAS  PubMed  Google Scholar 

  120. Hong KD, Kang S, Kalaskar S, Wexner SD (2014) Ligation of intersphincteric fistula tract (LIFT) to treat anal fistula: systematic review and meta-analysis. Tech Coloproctol 18:685–691

    CAS  PubMed  Google Scholar 

  121. Vergara-Fernandez O (2013) Ligation of intersphincteric fistula tract: what is the evidence in a review? World J Gastroenterol 19:6805–6813

    PubMed  PubMed Central  Google Scholar 

  122. Yassin NA, Hammond TM, Lunniss PJ, Phillips RK (2013) Ligation of the intersphincteric fistula tract in the management of anal fistula A systematic review. Colorectal Dis 15:527–553

    CAS  PubMed  Google Scholar 

  123. Sirany AM, Nygaard RM, Morken JJ (2015) The ligation of the intersphncteric fistula tract procedure for anal fistula: a mixed bag of results. Dis Colon Rectum 58:604–612

    PubMed  Google Scholar 

  124. Malakorn S, Sammour T, Khomvilai S, Chowchankit I, Gunarasa S, Kanjanasilp P, Thiptanakij C, Rojanasakulet A (2017) Ligation of intersphincteric fistula tract for fistula in ano: lessons learned from a decade of experience. Dis Colon Rectum 60(10):1065–1070

    PubMed  Google Scholar 

  125. Sun XL, Wen K, Chen YH, Xu ZZ, Wang XP (2019) Long-term outcomes and quality of life following ligation of the intersphincteric fistula tract for high transsphincteric fistulas. Colorectal Dis 21(1):30–37

    PubMed  Google Scholar 

  126. Parthasarathi R, Gomes RM, Rajapandian S, Sathiamurthy R, Praveenraj P, Senthilnathan P, Palanivelu C (2016) Ligation of the intersphincteric fistula tract for the treatment of fistula-in-ano: experience of a tertiary care centre in South India. Colorectal Dis 18(5):496–502

    CAS  PubMed  Google Scholar 

  127. van der Hagen SJ, Baeten CG, Soeters PB, Beets-Tan RG, Russel MG, van Gemert WG (2005) Staged mucosal advancement flap for the treatment of complex anal fistulas: pretreatment with noncutting setons and in case of recurrent multiple abscesses a diverting stoma. Colorectal Dis 7:513–518

    PubMed  Google Scholar 

  128. Sonoda T, Hull T, Piedmonte MR, Fazio VW (2004) Outcomes of primary repair of anorectal and rectovaginal fistulas using the endorectal advancement flap. Dis Colon Rectum 45:1622–1628

    Google Scholar 

  129. Tyler KM, Aarons CB, Sentovich SM (2007) Successful sphincter-sparing surgery for all anal fistula. Dis Colon Rectum 50(10):1535–1539

    PubMed  Google Scholar 

  130. Seow-Choen F, Nicholls RJ (1992) Anal fistula. Br J Surg 79:197–205

    CAS  PubMed  Google Scholar 

  131. Ellis CN (2010) Sphincter-preserving fistula management: What patients want. Dis Colon Rectum 53:1652–1655

    PubMed  Google Scholar 

  132. Lunniss PJ, Kamm MA, Phillips RKS (1994) Factors affecting continence after surgery for anal fistula. Br J Surg 81:1382–1385

    CAS  PubMed  Google Scholar 

  133. Casillas S, Hull TL, Zutshi M, Trzcinski R, Bast JF, Xu M (2005) Incontinence after a lateral internal sphincterotomy: are we underestimating it? Dis Colon Rectum 48:1193–1199

    PubMed  Google Scholar 

  134. Murad-Regadas SM, Fernandes GO, Ragadas FS et al (2013) How much of the internal sphincter may be divided during lateral sphincterotomy for chronic anal fissure in women? Morphologic and functional evaluation after sphincterotomy. Dis Colon Rectum 56:645–651

    PubMed  Google Scholar 

  135. Lindesy I, Smilgin-Humphreys MM, Cunningham C, Mortensen NJ, George BD (2002) A randomized, controlled trial of fibrin glue vs. conventional treatment for anal fistula. Dis Colon Rectum 45:1608–1615

    Google Scholar 

  136. Altomare DF, Greco VJ, Tricomi N et al (2011) Seton or glue for trans-sphincteric anal fistulae: a prospective randomized crossover clinical trial. Colorectal Dis 13:82–86

    CAS  PubMed  Google Scholar 

  137. Singer M, Cintron J, Nelson R et al (2005) Treatment of fistulasin-ano with fibrin sealant in combination with intra-adhesive antibiotics and/or surgical closure of the internal fistula opening. Dis Colon Rectum 48:799–808

    PubMed  Google Scholar 

  138. De Parades V, Safa Far H, Etienney I, Zeitoun JD, Atienza P, Bauer P (2010) Seton drainage and fibrin glue injection for complex anal fistulas. Colorectal Dis 12:459–463

    PubMed  Google Scholar 

  139. De Oca J, Millàn M, Jiménez A, Golda T, Biondo S (2011) Long-term results of surgery plus fibrin sealant for anal fistula. Colorectal Dis 14:e12–e15

    Google Scholar 

  140. Haim N, Neufeld D, Ziv Y et al (2011) Long-term results of fibrin glue treatment for cryptogenic perianal fistulas: a multicenter study. Dis Colon Rectum 54:1279–1283

    PubMed  Google Scholar 

  141. Buchanan GN, Bartram CI, Phillips RK et al (2003) Efficacy of fibrin sealant in the management of complex anal fistula: a prospective trial. Dis Colon Rectum 46:1167–1174

    PubMed  Google Scholar 

  142. Liao FT, Chang CJ (2018) Initial experience with fibrin glue treatment of anal fistulae in children. Am Surg 84(6):1105–1109

    PubMed  Google Scholar 

  143. Lara FJ, Serrano AM, Moreno JU, Carmona JH, Marquez MF, Pérez LR, del Rey MA, Muñoz HO (2014) Platelet-rich fibrin sealant as a treatment for complex perianal fistulas: a multicentre study. J Gastrointest Surg. 19(2):360–368

    PubMed  Google Scholar 

  144. de la Portilla F, Segura-Sampedro JJ, Reyes-Díaz ML, Maestre MV, Cabrera AM, Jimenez-Rodríguez RM, Vázquez-Monchul JM, Diaz-Pavón JM, Padillo-Ruiz FJ (2017) Treatment of transsphincteric fistula-in-ano with growth factors from autologous platelets: results of a phase II clinical trial. Int J Colorectal Dis 32(11):1545–1550

    PubMed  Google Scholar 

  145. Pérez Lara FJ, Hernández González JM, Ferrer Berges A, Navarro Gallego I, de Los O, Reyes H, Oliva Muñoz H (2018) Can Perianal Fistula Be Treated Non-surgically with Platelet-Rich Fibrin Sealant? J Gastrointest Surg. https://doi.org/10.1007/s11605-018-3932-5

    Article  PubMed  Google Scholar 

  146. Garcia-Olmo D, Herreros D, Pascual I et al (2009) Expanded adipose-derived stem cells for the treatment of complex perianal fistula: a phase II clinical trial. Dis Colon Rectum 52:79–86

    PubMed  Google Scholar 

  147. MD Herreros, M Garcia Arranz, H Guadalajara, P Quintana De la, D Garcia-Olmo, the FATT Collaborative group (2012) Autologous expanded adipose-derived stem cells for the treatment of complex cryptoglandular perianal fistulas: a phase III randomized clinical trial and long-term evaluation Dis Colon Rectum 55:762–772

  148. A ba-bai-ke-re MM, Wen H, Huang HG et al (2011) Randomized controlled trial of minimally invasive surgery using acellular dermal matrix for complex anorectal fistula. World J Gastroenterol 16 3279–3286

  149. Choi S, Ryoo SB, Park KJ, Kim DS, Song KH, Kim KH, Chung SS, Shin EJ, Cho YB, Oh ST, Kang WK, Kim MH (2017) Autologous adipose tissue-derived stem cells for the treatment of complex perianal fistulas not associated with Crohn's disease: a phase II clinical trial for safety and efficacy. Tech Coloproctol 21(5):345–353

    CAS  PubMed  Google Scholar 

  150. Cirocchi R, Trastulli S, Morelli U et al (2013) The treatment of anal fistulas with biologically derived products: is innovation better than conventional surgical treatment? Tech Coloproctol 17:259–273

    PubMed  Google Scholar 

  151. Philandrianos C, Serrero M, Grimaud F, Magalon J, Visée C, Velier M, Francois P, Orsoni P, Magalon G, Grimaud JC, Desjeux A, Véran J, Sabatier F (2018) First clinical case report of local microinjection of autologous fat and adipose-derived stromal vascular fraction for perianal fistula in Crohn's disease. Stem Cell Res Ther 9(1):4–8

    PubMed  PubMed Central  Google Scholar 

  152. Norderval S, Lundby L, Hougaard H, Buntzen S, Weum S, de Weerd L (2018) Efficacy of autologous fat graft injection in the treatment of anovaginal fistulas. Tech Coloproctol 22(1):45–51

    CAS  PubMed  Google Scholar 

  153. de Weerd L, Weum S, Norderval S (2015) Novel treatment for recalcitrant rectovaginal fistulas: fat injection. Int Urogynecol J 26(1):139–144

    PubMed  Google Scholar 

  154. Tremolada C, Colombo V, Ventura C (2016) Adipose tissue and mesenchymal stem cells: state of the art and Lipogems(R) technology development. Curr Stem Cell Rep 2:304–312

    CAS  PubMed  PubMed Central  Google Scholar 

  155. Naldini G, Sturiale A, Fabiani B, Giani I, Menconi C (2018) Micro-fragmented adipose tissue injection for the treatment of complex anal fistula: a pilot study assessing safety and feasibility. Tech Coloproctol 22:107–113

    CAS  PubMed  Google Scholar 

  156. Hammond TM, Porrett TR, Scott SM, Williams NS, Lunniss PJ (2011) Management of idiopathic anal fistula using cross-linked collagen: prospective phase 1 study. Colorectal Dis 13:94–104

    CAS  PubMed  Google Scholar 

  157. Sileri P, Franceschilli I, Del Vecchio BG, Stolfi VM, Angelucci GP, Gaspari AL (2011) Porcine dermal collagen matrix injection may enhance flap repair surgery for complex anal fistula. Int J Colorectal Dis 26:345–349

    PubMed  Google Scholar 

  158. Giordano P, Sileri P, Buntzen S, Stuto A, Nunoo-Mensah J, Lenisa L, Singh B, Thorlacius-Ussing O, Griffiths B, Ziyaie D (2017) Final results of a European multicenter, prospective, observational study of Permacol-collagen paste injection for the treatment of anal fistula. Colorectal Dis. Doi: 10.1111/codi.13715.

    CAS  PubMed  Google Scholar 

  159. Schiano di Visconte M, Braini A, Moras L, Brusciano L, Docimo L, Bellio G (2019) Permacol Collagen Paste injection for treatment of complex cryptoglandular anal fistulas An observational cohort study with 2-year follow-up. Surg Innov 26(2):168–179

    PubMed  Google Scholar 

  160. Bayrak M (2018) Altıntas Y (2018) Permacol™ collagen paste injection in anal fistula treatment: a retrospective study with one-year follow-up. Adv Ther. 35(8):1232–1238

    CAS  PubMed  Google Scholar 

  161. Fabiani B, Menconi C, Martellucci J, Giani I, Toniolo G, Naldini G (2017) Permacol™ collagen paste injection for the treatment of complex anal fistula: 1-year follow-up. Tech Coloproctol 21(3):211–215

    CAS  PubMed  Google Scholar 

  162. Köckerling F, Alam NN, Narang SK, Daniels IR, Smart NJ (2015) Treatment of fistula-in-ano with fistula plug—a review under special consideration of the technique. Front Surg 2:55

    PubMed  PubMed Central  Google Scholar 

  163. Narang SK, Jones C, Alam NN, Daniels IR, Smart NJ (2016) Delayed absorbable synthetic plug (GORE® BIO-A®) for the treatment of fistula-in-ano: a systematic review. Colorectal Dis 18(1):37–44

    CAS  PubMed  Google Scholar 

  164. Stamos MJ, Snyder M, Robb BW, Ky A, Singer M, Stewart DB, Sonoda T, Abcarian H (2015) Prospective multicenter study of a synthetic bioabsorbable anal fistula plug to treat cryptoglandular transsphincteric anal fistulas. Dis Colon Rectum 58(3):344–351

    PubMed  Google Scholar 

  165. Fisher OM, Raptis DA, Vetter D, Novak A, Dindo D, Hahnloser D, Clavien PA, Nocito A (2015) An outcome and cost analysis of anal fistula plug insertion vs endorectal advancement flap for complex anal fistulae. Colorectal Dis 17(7):619–626

    CAS  PubMed  Google Scholar 

  166. O’Riordan JM, Datta I, Johnston M, Baxter NN (2012) A systematic review of the anal fistula plug for patients with Crohn’s or non-Crohn’s related fistula-in-ano. Dis Colon Rectum 55:351–358

    PubMed  Google Scholar 

  167. Garg P, Gong J, Bhatia H, Kalia H, Menon GR (2010) The efficacy of anal fistula plug in fistula-in-ano: a systematic review. Colorectal Dis 12:965–970

    CAS  PubMed  Google Scholar 

  168. Bondi J, Avdagic J, Karlbom U, Hallböök O, Kalman D, Šaltytė Benth J, Naimy N, Øresland T (2017) Randomized clinical trial comparing collagen plug and advancement flap for trans-sphincteric anal fistula. Br J Surg. 104(9):1160–1166

    CAS  PubMed  Google Scholar 

  169. Xu Y, Tang W (2016) Comparison of an anal fistula plug and mucosa advancement flap for complex anal fistulas: a meta-analysis. ANZ J Surg 86(12):978–982

    CAS  PubMed  Google Scholar 

  170. Borreman P, de Gheldere C, Fierens J, Vanclooster P (2014) Can a flap help the plug? or vice versa? Proposing a combined sphincter-sparing anal fistularepair. Acta Chir Belg 114(6):376–380

    CAS  PubMed  Google Scholar 

  171. Han JG, Wang ZJ, Zheng Y, Chen CW, Wang XQ, Che XM, Song WL (2016) Cui JJ ligation of intersphincteric fistula tract vs ligation of the intersphincteric fistula tract plus a bioprosthetic anal fistula plug procedure in patients with transsphincteric anal fistula: early results of a multicenter prospective randomized trial. Ann Surg. 264(6):917–922

    PubMed  Google Scholar 

  172. Jayne DG, Scholefield J, Tolan D, Gray R, Edlin R, Hulme CT, Sutton AJ, Handley K, Hewitt CA, Kaur M, Magill L (2019) Anal fistula plug versus surgeon’s preference for surgery for trans-sphincteric anal fistula: the FIAT RCT. Health Technol Assess 23(21):1–76

    PubMed  PubMed Central  Google Scholar 

  173. Meinero P, Mori L (2011) Video-assisted anal fistula treatment (VAAFT): a novel sphincter-saving procedure for treating complex anal fistulas. Tech Coloproctol 15:417–422

    CAS  PubMed  PubMed Central  Google Scholar 

  174. Schwandner O (2013) Video-assisted anal fistula treatment (VAAFT) combined with advancement flap repair in Crohn’s disease. Tech Coloproctol 17:221–225

    CAS  PubMed  Google Scholar 

  175. Kochhar G, Saha S, Andley M et al (2014) Video-assisted anal fistula treatment. J Soc Laparoendosc Surg 18(e2014):00127

    Google Scholar 

  176. Meinero P, Mori L, Gasloli G (2014) Video-assisted anal fistula treatment. Dis Colon Rectum 57:354–359

    PubMed  Google Scholar 

  177. Wałęga P, Romaniszyn M, Nowak W (2014) VAAFT: a new minimally invasive method in the diagnostics and treatment of anal fistulas—initial results. Pol Przegl Chir 86:7–10

    PubMed  Google Scholar 

  178. Mendes CRS, de Ferreira LSM, Sapucaia RA et al (2014) Video-assisted anal fistula treatment: technical considerations and preliminary results of the first Brazilian experience. Arq Bras Cir Dig 27:77–81

    PubMed  PubMed Central  Google Scholar 

  179. Selvarajan A (2015) Video-assisted anal fistula treatment (VAAFT): Johor Bahru’s humble beginnings. Int J Integr Med Sci 2:175–177

    Google Scholar 

  180. Chowbey PK, Khullar R, Sharma A et al (2015) Minimally invasive anal fistula treatment (MAFT)—an appraisal of early results in 416 patients. Indian J Surg 77:716–721

    CAS  PubMed  Google Scholar 

  181. Zarin M, Khan MI, Ahmad M et al (2015) VAAFT: video assisted anal fistula treatment; bringing revolution in fistula treatment. Pak J Med Sci 31:716–721

    Google Scholar 

  182. Pini Prato A, Zanaboni C, Mosconi M et al (2016) Preliminary results of video-assisted anal fistula treatment (VAAFT) in children. Tech Coloproctol 20:279–285

    CAS  PubMed  Google Scholar 

  183. Seow-En I, Seow-Choen F, Koh PK (2016) An experience with video-assisted anal fistula treatment (VAAFT) with new insights into the treatment of anal fistulae. Tech Coloproctol 20:389–393

    CAS  PubMed  Google Scholar 

  184. Jiang H, Liu H, Li Z et al (2017) Video-assisted anal fistula treatment (VAAFT) for complex anal fistula: a preliminary evaluation in China. Med Sci Monit 23:2065–2071

    PubMed  PubMed Central  Google Scholar 

  185. Garg P, Singh P (2017). Video-assisted anal fistula treatment (VAAFT) in cryptoglandular fistula-in-ano: a systematic review and proportional meta-analysis. Int J Surg 46:85–91.

    PubMed  Google Scholar 

  186. Adegbola SO, Sahnan K, Pellino G et al (2017) Short-term efficacy and safety of three novel sphincter-sparing techniques for anal fistulae: a systematic review. Tech Coloproctol 21:775–782

    CAS  PubMed  Google Scholar 

  187. Emile SH, Elfeki H, Shalaby M, Sakr A (2018) A systematic review and meta-analysis of the efficacy and safety of video-assisted anal fistula treatment (VAAFT). Surg Endosc. 32(4):2084–2093

    PubMed  Google Scholar 

  188. Giamundo P, Geraci M, Tibaldi L, Valente M (2014) Closure of fistula-in-ano with laser–FiLaC: a novel sphincter saving technique for a complex disease. Colorectal Dis 16:110–115

    CAS  PubMed  Google Scholar 

  189. Wilhelm A (2011) A new technique for sphincter-preserving anal fistula repair using a novel radial emitting laser probe. Tech Coloproctol 15:445–449

    CAS  PubMed  Google Scholar 

  190. Giamundo P, Esercizio L, Geraci M, Tibaldi L, Valente M (2015) Fistula-tract Laser Closure (FiLaC™): long-term results and new operative strategies. Tech Coloproctol 19(8):449–453

    CAS  PubMed  Google Scholar 

  191. Wilhelm A, Fiebig A, Krawczak M (2017) Five years of experience with the FiLaC laser for fistula-in-ano management: long-term follow-up froma single institution. Tech Coloproctol 21(4):269–276

    CAS  PubMed  PubMed Central  Google Scholar 

  192. Terzi MC, Agalar C, Habip S, Canda AE, Arslan NC, Obuz F (2018) Closing perianal fistulas using a laser: long term results in 103 patients. Dis Colon Rectum 61(5):599–603

    PubMed  Google Scholar 

  193. Lauretta A, Falco N, Stocco E, Bellomo R, Infantino A (2018) Anal fistula laser closure: the length of fistula is the Achille’s heel. Tech Coloproctol 22(12):933–939

    CAS  PubMed  Google Scholar 

  194. Prosst RL, Joos AK, Ehni W, Bussen D, Herold A (2016) Prospective pilot study of anorectal fistula closure with the OTSC proctology. Colorectal Dis 171(1):81–86

    Google Scholar 

  195. Prosst RL, Joos AK (2016) Short-term outomes of a novel endoscopic clipping device for closure of the internal opening in 100 anorectal fistulas. Tech Coloproctol 20(11):753–758

    CAS  PubMed  Google Scholar 

  196. Mennigen R, Laukötter M, Senninger N, Rijcken E (2015) The OTSC proctology clip system for the closure of refractory anal fistulas. Tech Coloproctol 19:241–246

    CAS  PubMed  Google Scholar 

  197. Gautier M, Godeberge P, Ganansia R, Groupe de Recherche en Proctologie SNFCP France et al. (2015) Easy clip to treat anal fistula tracts: a word of caution. Int J Colorectal Dis 30:621–624.

    CAS  PubMed  Google Scholar 

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Amato, A., Bottini, C., De Nardi, P. et al. Evaluation and management of perianal abscess and anal fistula: SICCR position statement. Tech Coloproctol 24, 127–143 (2020). https://doi.org/10.1007/s10151-019-02144-1

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