Which treatment for anal fistula? Cut or cover, plug or paste, loop or lift.
2012
Anorectal fistulas are common maladies. The challenge in therapy of perianal
fistulas balances between the best possible cure and the preservation of
continence. Complex fistulous disease challenges even the most experienced
surgical specialists. The management options in these groups of patients are
inadequate, with treatment often requiring multiple procedures, causing a
risk for continued symptoms and fecal incontinence. This has lead to a
serious search for newer and safer treatment options. Use of different types
of setons and advancement flaps have their own advantages and pitfalls.
Invasive methods with high rates of incontinence have given way to
sphincter-sparing methods that have a much lower associated morbidity.
Treatment with fibrin glue is an attractive option whenever continence might
be endangered by operative procedures. Initial results with fistula plugs are
promising but need further critical observations. Recently, the ligation of
fistula tract had shown few promising results though it will be too early to
comment on its long-term efficacy.
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