Abstract

CURRENT APPROACHES FOR MANAGEMENT OF FISTULA IN ANO: A REVIEW

Lakshmikant Shukla*, Prabhanshu Gupta and Prajakta Korde

ABSTRACT

Anal fistulas are caused by occluded and infected anal glands in the intersphincteric plane, resulting in cryptoglandular abscesses. The incidence is 8.6 per 100,000 and is classified into five grades. Factors causing anorectal fistulas include foreign bodies, radiation, infection, epithelialization, neoplasm, and distal obstruction. Risk factors include obesity, diabetes, hyperlipidemia, surgery history, salt intake, smoking, and patients younger than 40 or with recurrent abscesses. Diagnosis is essential using imaging techniques like endo-anal ultrasound, CT pelvis, CT-fistulography, and MRI of the pelvis. Anal fistulas have varying prognosis, with simple fistulas having healing rates of around 80% and complex fistulas having around 60% for sphincter preserving operations. Setons have been used with success up to 80 to 90%, but failure can occur due to incomplete division, resection, or ligation. Treatment options vary, with fistulotomy being the gold standard for acute anal fistulas. Prevention is key, including minimizing procedures, tailoring therapy for high-risk patients, counseling patients on fecal incontinence risks, and obtaining preoperative imaging to classify fistulas more accurately.

Keywords: Anal Fistula, Anorectal, Ligation of Intersphincteric Fistula Tract, Plug, Fibrin, Glue.