gastrointestinal disorders
Anorectal Fistula
Treatment of Anorectal Fistula
Various surgical procedures Medical treatment if caused by Crohn disease (See also the American Society of Colon and Rectal Surgeons'2016 clinical practice guidelinefor the management of anorectal abscess, fistula-in-ano, and rectovaginal fistula.) Previously, the only effective treatment was fistulotomy or fistulectomy, in which the primary opening and the entire tract are unroofed and converted into a “ditch.” Partial division of the sphincters may be necessary. Some degree of incontinence may occur if a considerable portion of the sphincteric ring is divided. Currently, alternative treatments include advancement flaps, biologic plugs, and fibrin glue instillations into the fistulous tract. More recently, the ligation of intersphincteric fistula tract (LIFT) procedure, where the fistula tract is divided between the sphincter muscles, is an alternative more likely to preserve continence. If diarrhea or Crohn disease is present, fistulotomy is inadvisable because of delayed wound healing and of the potential for fecal incontinence. , other appropriate antibiotics, and suppressive therapies can be given (see Crohn Disease ). 