ABSTRACT

Anal fistula is an abnormal passageway between the anal canal and the skin around the anus. It usually results from previous anal abscesses but can also be associated with other conditions such as Crohn’s disease. Intersphincteric fistulas are the most common type and cross only the internal sphincter. Transsphincteric fistulas pass through both the internal and external sphincters. Transsphincteric and recurrent fistulas remain a surgical challenge. Treatment usually involves surgery and depends on the position of the fistula in relation to the sphincters. Simple division, i.e., fistulotomy, will likely result in fecal incontinence. Various surgical treatment options for complex fistulas have shown disappointing results. Recently a biologic anal fistula plug was developed to treat complex fistulas.