JLE

Hépato-Gastro & Oncologie Digestive

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Anal fistula: the end of the story? Volume 18, issue 3, Mai-Juin 2011

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Authors
Hôpital Paris-Saint-Joseph, Institut de proctologie Léopold-Bellan, 185, rue Raymond-Losserand, 75014 Paris, France, Hôpital Bichat, 46 rue Henri-Huchard, 75018 Paris, France

Abscess and anal fistula are two stages of the same disease. Healing fistula without incontinence is the challenge. The risk of impairment of continence discriminates between simple and complex fistula. Simple fistula can be layed open without significant risk for incontinence: fistulotomy is then the treatment of choice. To preserve from impairment of continence, the drainage with seton is useful for staged fistulotomy or sphincter saving strategy. This includes mucosal flap obliteration of the primary orifice of the fistula, or filling the fistula track with glue or collagen. These methods are not usable in all fistulas. Best results are obtained in single-track fistula. The preservation of continence is achieved by these methods of filling the tract but relapse of fistula occurs in up to 50%. Quality of life depends on postoperative relapse of fistula and continence. It is actually still difficult to compare the results of these different treatments.