Anal fistula remains nowadays a concern for surgeons. It is a complicated disease because it affects the anal sphincters location and infection is always present to some degree. Moreover, surgical treatment should be adapted to fistula characteristics but being aware of patient conditions. Fistula classification, based on preoperative images, and patient continence status before surgery should be kept in mind in the process of choosing the best surgical option.
A comprehensive review of the main surgical techniques for an anal fistula of cryptoglandular origin is presented, describing indications, surgical techniques, and results of each type. Setons, fistulotomy and fistulectomy, ligation of intersphincteric fistula tract (LIFT) procedure, rectal advancement flaps, and other preserving sphincter techniques (fibrin glue, anal fistula plug, stem cells, and FilaC) are discussed.
An adequate balance between fistula tract surgery with a pleasant treatment of anal sphincters is the key to success, resulting in a high postoperative healing rate (or a low recurrence rate) without continence disturbances.
The possibility of choosing between different operations brings the opportunity to the surgeon to perform a tailored fistula treatment.