Management of fistula-in-ano: An introduction

Core Tip

A fistula-in-ano is a granulating track between the anorectum and the perineum. A fistula may consist of primary and secondary tracks. Many fistulas are low lying, consisting of a single straight track from the skin to the anal canal, just passing through the lower fibers of the internal sphincter The majority of such fistulas can, therefore, be managed by simply lying opening the track (fistulotomy), which produces a good prospect of cure and with no impairment of continence. However, the same can not be said for fistulae which pass through the external sphincter. Some of these fistulas are complex, with secondary pararectal or supralevator tracks. Opening such fistulas may be risky and there is growing evidence that even division of a part of the external sphincter leaving the puborectalis undisturbed is associated with considerable impairment of anorectal function[1]. Unless all the secondary tracks are also treated, there is a risk of recurrent sepsis and fistulation.