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World J Gastroenterol. Jul 28, 2011; 17(28): 3277-3285
Published online Jul 28, 2011. doi: 10.3748/wjg.v17.i28.3277
Idiopathic fistula-in-ano
Sherief Shawki, Steven D Wexner
Sherief Shawki, Steven D Wexner, Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL 33331, United States
Sherief Shawki, Department of Surgery, Suez Canal University, Ismailia 41225, Egypt
Correspondence to: Steven D Wexner, MD, FACS, FRCS, FRCS(Ed), Professor of Surgery, Cleveland Clinic Florida, 2950, Cleveland Clinic Boulevard, Weston, FL 33331, United States.
Telephone: +1-954-659-5278 Fax: +1-954-659-5252
Received: February 21, 2011
Revised: July 6, 2011
Accepted: July 13, 2011
Published online: July 28, 2011

Fistula-in-ano is the most common form of perineal sepsis. Typically, a fistula includes an internal opening, a track, and an external opening. The external opening might acutely appear following infection and/or an abscess, or more insiduously in a chronic manner. Management includes control of infection, assessment of the fistulous track in relation to the anal sphincter muscle, and finally, definitive treatment of the fistula. Fistulotomy was the most commonly used mode of management, but concerns about post-fistulotomy incontinence prompted the use of sphincter preserving techniques such as advancement flaps, fibrin glue, collagen fistula plug, ligation of the intersphincteric fistula track, and stem cells. Many descriptive and comparative studies have evaluated these different techniques with variable outcomes. The lack of consistent results, level I evidence, or long-term follow-up, as well as the heterogeneity of fistula pathology has prevented a definitive treatment algorithm. This article will review the most commonly available modalities and techniques for managing idiopathic fistula-in-ano.

Keywords: Anal fistula, Seton, Fistulotomy, Advancement flap, Fibrin glue, Fistula plug