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The ASCRS Textbook of Colon and Rectal Surgery pp 245–274Cite as

Complex Anorectal Fistulas

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Abstract

The optimal management of complex anorectal fistulas such as recurrent fistula-in-ano, rectourethral fistula, and ileal-pouch fistula remains the subject of ongoing scientific research and academic debate. While numerous surgical procedures are available, overall there is absence of a standardized approach to the treatment of such conditions due to the lack of randomized clinical trial data, heterogeneity of patient populations reported in various studies, and wide ranges of reported outcome. When faced with a patient with anorectal fistulous disease, the aim of any intervention is to eradicate the fistula, to prevent recurrence, to minimize postoperative complications, and to preserve anal continence. The history and physical examination along with selective imaging to delineate the anatomy of the fistula are critical to individualize the patient’s treatment. When possible, simple procedures should be attempted first if there is a potential for success before more complex procedures are considered. It is important to convey to the patient the expectations and limitations of surgical treatment, including the need for multiple operations, the risk of failure, and the potential poor anorectal and urinary function.

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Author information

Authors and Affiliations

  1. Department of Surgery, Treviso Regional Hospital, Treviso, Italy

    Giulio A. Santoro MD, PhD

  2. Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, 6th Floor Swing Wing, Al-Maryah Island, 112412, Abdu Dhabi, United Arab Emirates

    Maher A. Abbas MD, FACS, FASCRS

Authors
  1. Giulio A. Santoro MD, PhD
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  2. Maher A. Abbas MD, FACS, FASCRS
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Corresponding author

Correspondence to Maher A. Abbas MD, FACS, FASCRS .

Editor information

Editors and Affiliations

  1. Division of Colorectal Surgery, University Hospitals Case Medical Center Case Western Reserve University, Cleveland, OH, USA

    Scott R. Steele

  2. Cleveland Clinic, Cleveland, OH, USA

    Tracy L. Hull

  3. Tufts University School of Medicine, Lahey Hospital & Medical Center, Burlington, MA, USA

    Thomas E. Read

  4. Ambrose and Gladys Bowyer, Loyola University, Chicago, IL, USA

    Theodore J. Saclarides

  5. University of Texas Medical Branch at Galveston, Galveston, TX, USA

    Anthony J. Senagore

  6. Ochsner Medical Center, New Orleans, LA, USA

    Charles B. Whitlow

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

LIFT procedure. Mark the intersphincteric groove. Courtesy of Sarah Vogler, MD (M4V 4084 kb)

LIFT procedure. Dissect out the tract in the groove. Courtesy of Sarah Vogler, MD (M4V 26,172 kb)

LIFT procedure. Open the external opening. Courtesy of Sarah Vogler, MD (M4V 7595 kb)

LIFT procedure. Suture ligate the tract in the groove. Courtesy of Sarah Vogler, MD (M4V 20,815 kb)

LIFT procedure. Divide the tract after ligation. Courtesy of Sarah Vogler, MD (M4V 22,172 kb)

LIFT procedure. Oversew the tract. Courtesy of Sarah Vogler, MD (M4V 10,502 kb)

LIFT procedure. Test the tract to ensure not still open with H2O2. Courtesy of Sarah Vogler, MD (M4V 19,147 kb)

LIFT procedure. Closure of the wound. Courtesy of Sarah Vogler, MD (M4V 2826 kb)

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© 2016 ASCRS (American Society of Colon and Rectal Surgeons)

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Santoro, G.A., Abbas, M.A. (2016). Complex Anorectal Fistulas. In: Steele, S.R., Hull, T.L., Read, T.E., Saclarides, T.J., Senagore, A.J., Whitlow, C.B. (eds) The ASCRS Textbook of Colon and Rectal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-25970-3_15

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  • DOI: https://doi.org/10.1007/978-3-319-25970-3_15

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  • Print ISBN: 978-3-319-25968-0

  • Online ISBN: 978-3-319-25970-3

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