Treatment of cryptoglandular fistulas with the fistula tract laser closure (FiLaC™) method in comparison with standard methods: first results of a multicenter retrospective comparative study in the Netherlands

Understanding the anatomical basis of anorectal fistulas and their surgical management: exploring different types for enhanced precision and safety

Anorectal fistulas remain one of the most challenging conditions in colorectal surgery and require precise anatomical knowledge for successful management. This comprehensive review synthesizes the current evidence on the anatomical foundations of fistula development and treatment, particularly focusing on the cryptoglandular hypothesis and its clinical implications. A systematic analysis of the recent literature has examined the relationship between anatomical structures and fistula formation, classification systems, diagnostic modalities, and therapeutic approaches. The review revealed that anatomical considerations fundamentally influence treatment outcomes, with modern imaging techniques achieving up to 98% accuracy in delineating fistula anatomy. Key findings demonstrate that surgical success rates vary significantly based on anatomical complexity: 92-97% for simple fistulas versus 40-95% for complex cases using sphincter-sparing techniques. Emerging minimally invasive approaches and regenerative therapies, including mesenchymal stem cells, show promising results with 50-60% healing rates in complex cases. Special considerations are needed for complex cases such as Crohn's disease-related and rectovaginal fistulas. This review provides surgeons with an evidence-based framework for selecting optimal treatment strategies based on anatomical considerations, emphasizing the importance of preserving the anal sphincter function while achieving complete fistula eradication. Integrating advanced imaging, surgical techniques, and emerging therapies offers new possibilities for improving patient outcomes. This review aimed to bridge the gap between anatomical knowledge and practical surgical application, enhance clinical decision-making, and improve patient outcomes in anorectal fistula management.

[On fistulas and threads : Sense and nonsense of seton drainage]

BACKGROUND

In the daily practice of a large proctological center numerous wrong or misplaced fistula threads are encountered. This indicates that there are misconceptions and knowledge gaps in this surgical field in nonspecialized general surgeons.

MATERIAL AND METHODS

Comprehensive footage of own experiences in a proctological center shows faulty threads and correct loop placement.

RESULTS

In fistula treatment there is still a distinct need for improvement. This synopsis is an educational contribution.

CONCLUSION

In the case of a lack of experience in proctological surgery, education and training has to be provided for the decent management of anal fistulas with correct threads.