Vol. 9, Issue 3, Part A (2025)

This article examines and compares surgical methods for treating anal fistulas, especially in patients with Crohn’s disease, by reviewing studies published from 2013 to 2023. For straightforward anal fistulas, fistulotomy is commonly used due to its high success rate, but it can lead to urinary incontinence in some cases. More complicated fistulas, which are often seen in Crohn’s disease, are usually managed with techniques designed to preserve the sphincter muscle. These include the ligation of the inter-sphincteric fistula tract (LIFT), rectal advancement flap procedures, as well as newer approaches like video-assisted anal fistula treatment (VAAFT) and fistuloscopic laser closure (FiLaC).
The review assessed the quality of the included studies by considering their methodology, sample sizes, and reported outcomes. Findings showed that while traditional fistulotomy is effective in preventing recurrence, it carries a greater risk of urinary incontinence, particularly in complex cases. Sphincter-sparing options such as LIFT and FiLaC generally result in fewer complications and lower morbidity, but the likelihood of the fistula returning remains a challenge. The decision on which surgical technique to use depends on several factors, including the complexity of the fistula, whether the patient already has urinary control issues and any other existing health problems.
Ultimately, the review highlights the need for ongoing research, standardized definitions, consistent methods for measuring outcomes, and longer follow-up periods to improve the management of anal fistulas, particularly in patients with Crohn’s disease. Individualized treatment planning remains essential to optimize patient results.