Official websites use. Share sensitive information only on official, secure websites. Anal fistula AF presents a chronic problem for patients and colorectal surgeons alike. Surgical treatment may result in impairment of continence and long-term risk of recurrence. Treatment options for AFs vary according to their location and complexity. The ideal approach should result in low recurrence rates and minimal impact on continence.
New technical approaches involving biologically derived products such as biological mesh, fibrin glue, fistula plug, and stem cells have been applied in the treatment of AF to improve outcomes and decrease recurrence rates and the risk of fecal incontinence. In this review, we will highlight the current evidence and describe our personal experience with these novel approaches.
Keywords: anal fistula, biologic mesh, fibrin glue, fistula plug, bio-LIFT, stem cells. CME Objectives: After reading this article, the reader should be able to understand the role of biologic and synthetic materials for treatment of anal fistula.
An anal fistula AF is an abnormal communication between the anal glands and the perianal skin. Reliable data on incidence of AF in the general population are not available, but in an epidemiologic study performed in four European countries England, Germany, Italy, and Spain , the incidence reported was between 12 and 28 per , Patients younger than 40 years had a higher likelihood of developing an AF during a mean follow-up of 38 months.
Any recurrent abscess presenting at the same site should raise the suspicion of a fistula and be treated as such. Fistulas that are secondary to these processes are classified as complex and require the use of nonstandard methods of management. In , Parks et al 6 classified AF in four different types according to their passage through the sphincteric planes: intersphincteric, transsphincteric, suprasphincteric, and extrasphincteric Table 1. The most common presentation is intersphincteric, followed by transsphincteric.
