Abstract
Cryptoglandular anal fistulas are one of the most common colorectal diseases and occur
with an incidence of about 20/100,000. Anal fistulas are defined as an inflammatory
junction between
the anal canal and the perianal skin. They develop from an abscess or chronic infection
of the anorectum. Surgical treatment of the disease is the method of choice. Even
when treating an
acute abscess, its cause should be sought at the same time. If there is a connection
to the anal canal without affecting relevant parts of the sphincter muscles, primary
fistulotomy should
be performed. If larger parts of the sphincter muscle are involved, the insertion
of a seton drain is usually useful. There are essentially two recommendations for
the elective treatment
of cryptoglandular anal fistulas. Distal fistulas should be excised, with the proviso
that as little sphincter muscle as possible is sacrificed. In the case of highly proximally
located
and complex fistulas, sphincter-preserving surgical techniques should be used. In
this case, the method of choice is the mucosal or advancement flap. Alternatively,
clips, fibrin
injections, fistula plugs, fistula ligatures, or laser-based procedures are described
in the literature. In the case of intermediate fistulas, a fistulectomy with primary
sphincter
reconstruction can be useful. Every operation is carried out as a compromise between
definitive healing of the fistula and a potential risk to the patient’s continence.
It is often
difficult to make a reliable prognosis about the continence function to be expected
postoperatively. In addition to the fistula morphology, particular attention should
be paid to whether
previous proctological operations have already been performed, the gender of the patient,
and whether there are pre-existing sphincter dysfunctions. Since the surgeon’s expertise
plays a
decisive role in the success of the treatment, the procedure should be carried out
in a specialist proctological centre, especially in the case of complex fistulas or
in the case of a
condition after previous operations. In addition to the classic procedures, such as
fistulectomy or the plastic fistula closure, this article examines alternative methods
and their areas
of application.
Keywords
anal fistula - anal abscess - therapy - closure of fistula - continence function
