Indian Journal of Surgery

, Volume 80, Issue 6, pp 606–608 | Cite as

Garg Classification for Anal Fistulas: Is It Better than Existing Classifications?—a Review

  • Pankaj GargEmail author
Review Article


Classifying a disease is important as it helps in categorizing the disease according to its severity and also guide the treating physician regarding the management of the disease. There are three classifications in vogue for fistula-in-ano—Parks, St James university hospital, and Standard Practice Task Force classification. These existing classifications were compared with the recently proposed Garg classification. The grading of earlier three classifications do not correlate with the severity of the disease and also does not provide any input about the management. Garg classification correlate quite well with the disease severity and also guides the surgeon regarding the management of the disease (fistulotomy can be safely done in Garg grade I-II and should never be attempted in Garg grade III-V). Thus, Garg classification should be used by surgeons and radiologists.


Anal fistula Classification Parks Fistulotomy Sphincter 


Compliance with Ethical Standards

Conflict of Interest

The author declares that there is no conflict of interest.


  1. 1.
    Parks AG, Gordon PH, Hardcastle JD (1976) A classification of fistula-in-ano. Br J Surg 63:1–12CrossRefGoogle Scholar
  2. 2.
    Morris J, Spencer JA, Ambrose NS (2000) MR imaging classification of perianal fistulas and its implications for patient management. Radiographics 20:623–635 discussion 635–627CrossRefGoogle Scholar
  3. 3.
    Whiteford MH, Kilkenny J 3rd, Hyman N et al (2005) Practice parameters for the treatment of perianal abscess and fistula-in-ano (revised). Dis Colon rectum 48:1337–1342CrossRefGoogle Scholar
  4. 4.
    Garg P (2017) Comparing existing classifications of fistula-in-ano in 440 operated patients: is it time for a new classification? Int J Surg 42:34–40CrossRefGoogle Scholar
  5. 5.
    Garg P, Singh P, Kaur B (2017) Magnetic resonance imaging (MRI): operative findings correlation in 229 fistula-in-ano patients. World J Surg 41:1618–1624CrossRefGoogle Scholar
  6. 6.
    Garg P (2017) Supralevator extrasphincteric fistula-in-ano are rare as supralevator extension is almost always in the intersphincteric plane. World J Surg 41:2409–2410CrossRefGoogle Scholar
  7. 7.
    Garg P, Song J, Bhatia A, Kalia H, Menon GR (2010) The efficacy of anal fistula plug in fistula-in-ano: a systematic review. Color Dis 12:965–970CrossRefGoogle Scholar
  8. 8.
    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 18:685–691CrossRefGoogle Scholar
  9. 9.
    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 46:85–91CrossRefGoogle Scholar
  10. 10.
    Garg P, Garg M (2015) PERFACT procedure: a new concept to treat highly complex anal fistula. World J Gastroenterol 21:4020–4029CrossRefGoogle Scholar
  11. 11.
    Garg P (2017) Transanal opening of intersphincteric space (TROPIS)—a new procedure to treat high complex anal fistula. Int J Surg 40:130–134CrossRefGoogle Scholar

Copyright information

© Association of Surgeons of India 2018

Authors and Affiliations

  1. 1.Garg Fistula Research InstitutePanchkulaIndia

Personalised recommendations