Treatment Modalities of perianal fistula

Abstract

Background: As bacteria continuously enter into the fistula through the internal opening and the inflammation inside the fistula persists, the anal fistula cannot heal spontaneously. So, treatment for fistula-in-ano is almost universally surgical. The goal of surgical treatment of perianal fistula is permanent eradication of the supportive process without compromising anal continence. There are several surgical options for the treatment of perianal fistula, and the best choice is determined by the anatomy of the fistula: fistulotomy with opening and unroofing of the fibrous portion of the tract, fistulectomy with excession of the tract, or seton may be used as a drain placed through a fistula to maintain drainage and/or induce fibrosis. As there is no single technique is appropriate for the treatment of all fistula-in-ano   there   are   variable   surgical     procedures    for    the management of anal fistula  including  fistulotomy, fistulectomy, ligation of intersphincteric fistula tract, setons , fibrin glue, fibrin  plug, and  endo advancement flap. There are a number of sphincter-sparing methods for the treatment of perianal fistula such as fibrin glue injection, anal fistula plug, endorectal muscular or mucosal advancement flap, core-out fistulectomy, radiofrequency ablation, ligation of the intersphincteric fistula tract, and, finally, video-assisted anal fistula treatment.