New Treatment Methods For Anal Fistules: Can a Forward - Looking Standard Algorithm Occur?
Özet
Anal fistulas are challenging diseases that have been struggled with since ancient medical eras, and their ideal treatment is based on the principles of sepsis control, fistula closure, and maintaining continence. Perianal fistulas are categorized into two main groups as simple and complex according to the American Gastroenterological Association classification to facilitate operative decision-making. Simple fistulas, including subcutaneous, intersphincteric, or low transsphincteric fistulas, involve very little of the sphincter muscle complex and can be easily treated with high success rates and low incontinence risk using methods such as fistulotomy or marsupialization. Conversely, complex fistulas like high transsphincteric, suprasphincteric, and extrasphincteric fistulas involve a significant portion of the sphincter musculature, carry a higher risk of incontinence, and require staged treatments, seton placement, or modern sphincter-sparing techniques. Current management options include fistulectomy providing surgical excision, seton placement inducing fibrosis, sphincter-sparing LIFT, video-assisted anal fistula treatment (VAAFT), FiLAC utilizing a radial laser probe, endoanal advancement flap, anal fistula plug, and fibrin glue injection. In Crohn's patients, a combination of medical anti-TNF therapy and surgical loose seton is the primary approach. Consequently, while surgical preferences vary across centers, the new guideline algorithm proposed by Garg in 2021, which divides fistulas into five categories, stands out as the most up-to-date, standard, and appropriate treatment protocol.
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