Complex Anorectal Fistulas

  • Giulio A. Santoro
  • Maher A. AbbasEmail author


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.


Advancement flap Anal flap Anal plug Anorectal fistula Complex fistula Graciloplasty Ileal-pouch fistula Postoperative fistula Rectourethral fistula Recurrent fistula Sphincter reconstruction 

Supplementary material

Video 15.1

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

Video 15.2

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

Video 15.3

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

Video 15.4

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

Video 15.5

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

Video 15.6

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

Video 15.7

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

Video 15.8

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


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Authors and Affiliations

  1. 1.Department of SurgeryTreviso Regional HospitalTrevisoItaly
  2. 2.Department of Colorectal SurgeryDigestive Disease Institute, Cleveland Clinic Abu DhabiAbdu DhabiUnited Arab Emirates

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