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Invited Critique
Sep 2011

Still Looking for the Ideal Procedure for Complex Anal Fistula TreatmentComment on “Predictors of Outcome for Anal Fistula Surgery”

Author Affiliations

Author Affiliation: San Francisco Surgical Medical Group, San Francisco, California.

Arch Surg. 2011;146(9):1016. doi:10.1001/archsurg.2011.200

The basic surgical principle for the treatment of anal fistula of the cryptoglandular variety is simple: the identification of the primary opening, eradication of the infection, and exposure of the fistula tract. In reality, it is far from simple. Complex anal fistulas with significant involvement of the deep external anal sphincter challenged our pioneering surgeons decades ago, and they continue to challenge us now. In general, the more superficial the fistula tract, the easier it is to cure the disease, and anal fistulotomy or fistulectomy will have a very good outcome, with no recurrence and no incontinence. The high transsphincteric and suprasphincteric fistulas are a different story.

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