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More Shades of Grey than Black and White: A brief Review of management of Anorectal fistula

Authors:

Ranjana Wickrama Seneviratne ,

Faculty of Medicine, University of Ruhuna, LK
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Muruththa Marennage Janak Kumara,

Faculty of Medicine, University of Ruhuna, LK
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Pinnaduwage Vijitha De Silva

University of Ruhuna, LK
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Abstract

Search for ideal treatment of perianal fistula which will fulfill the objectives of low recurrence rate, minimal incontinence and good quality of life continues. Widely used methods for declination of fistula is include examination under anesthesia (EUA), endoanal ultrasound (EUS) and MRI, which is the gold standard. Wide range of procedures have been developed from simple ones such as loose seton to sphincter saving fistular plugs ending with extreme options such as temporary or permanent fecal diversion. Innovative therapeutic techniques such as the use of laser and adipose stem cells have shown some successes but require more advancements and improvements before been accepted in to wider practice. While simple fistulas can be managed without much difficulty options for complex ones need careful selection. Sphincter saving options are widely preferred. Success of Ligation of intersphincteric fistular tract (LIFT) appears to be popular. Endorectal advancement flap (ERAF) is accepted by many as the Gold standard for treatment of recurrent complex anal fistula. Many surgeons judiciously combine different techniques employing them sequentially or simultaneously to enhance success rate and mitigate disadvantages. Repeated operations are performed without much hesitation provided they are sphincter saving as healing can arrive at any stage of the disease. Management of fistulas associated with Crohn’s disease is a particularly complex entity requiring multidisciplinary involvement and multimodality treatment. Research continues seeking more successful options but it appears unlikely that given the variability in presentation and complexity of the disease a single successful method of treatment will ever be found for management of perianal fistula.
How to Cite: Seneviratne, R.W., Kumara, M.M.J. and De Silva, P.V., 2018. More Shades of Grey than Black and White: A brief Review of management of Anorectal fistula. Anuradhapura Medical Journal, 11(1), pp.25–30. DOI: http://doi.org/10.4038/amj.v11i1.7609
Published on 04 Sep 2018.
Peer Reviewed

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