Management of Anal Fistulas and Perianal Conditions

Anal fistulas and related perianal disorders represent a spectrum of conditions arising from infection, inflammation or adjacent disease processes within the anorectal region. Clinical management begins with accurate diagnosis, often relying on clinical examination supplemented by high-resolution imaging techniques such as magnetic resonance imaging to delineate fistula anatomy and detect abscess formation. Initial treatment of perianal abscess typically involves prompt drainage, while anal fistulas require a balance between definitive eradication of the tract and preservation of anal sphincter function. Traditional sphincter-preserving options include seton placement, ligation of the intersphincteric fistula tract and endorectal advancement flap procedures, each offering distinct advantages and potential complications. Emerging approaches such as laser ablation, biomaterial plugs and stem-cell therapies seek to reduce recurrence and incontinence. Management strategies also vary by patient group: infants with perianal abscess may often be treated conservatively, whereas adults frequently require surgical intervention. A multidisciplinary approach that integrates colorectal surgery, radiology and microbiology is critical to optimise outcomes, tailoring treatment to fistula complexity, underlying pathology and patient preferences.

Research from Nature Portfolio

In infants with perianal abscesses managed without surgery over extended follow-up, conservative treatment achieved cure in the majority of cases, with a minority progressing to fistula formation or requiring delayed operative care. These observations support initial non-operative management in selected paediatric populations. A long-term retrospective study of adult anal fistula surgery demonstrated varied closure and recurrence rates across techniques: fistulotomy and cutting-seton yielded high healing rates with minimal continence impairment, whereas fistula plugs were associated with higher failure rates. These findings underline the ongoing need to refine technique selection based on fistula anatomy and patient risk factors.

Management of Anal Fistulas and Perianal Conditions publication trend

The graph below shows the total number of articles in management of anal fistulas and perianal conditions across all publications each year (not limited to Nature Index journals).

Technical terms

Anal fistula: An abnormal channel connecting the anal canal or rectum to the perianal skin, typically arising from infection of anal glands.

Perianal abscess: A localized collection of pus in the tissues surrounding the anus, often the precursor to fistula formation.

Ligation of the intersphincteric fistula tract (LIFT): A sphincter-preserving surgical technique that isolates and ties off the fistula tract in the intersphincteric plane.

Endorectal advancement flap: A procedure in which rectal mucosa and submucosa are mobilised to cover the internal fistula opening after curettage of the tract.

Microbiome: The community of microorganisms resident in a particular environment, such as skin or gut, influencing health and disease.

References

1. Microbiomic signatures of anal fistula and putative sources of microbes. Frontiers in Cellular and Infection Microbiology (2024).
2. Evaluation of Reporting Methods for Assessment and Surgical Planning of Perianal Fistulas. Journal of Imaging Informatics in Medicine (2025).
3. Natural course of perianal abscess in infants: a real-world study. Scientific Reports (2023).
4. Differences in Gut Microbiota between Healthy Individuals and Patients with Perianal Abscess before and after Surgery. Mediators of Inflammation (2023).
5. Systematic review and meta-analysis of endorectal advancement flap and ligation of the intersphincteric fistula tract for cryptoglandular and Crohn's high perianal fistulas. BJS Open (2019).
6. Five years of experience with the FiLaC™ laser for fistula-in-ano management: long-term follow-up from a single institution. Techniques in Coloproctology (2017).
7. Advances in the Treatment of Anal Fistula: A Mini-Review of Recent Five-Year Clinical Studies. Frontiers in Surgery (2021).
8. Treatment of Fistula-In-Ano with Fistula Plug – a Review Under Special Consideration of the Technique. Frontiers in Surgery (2015).
9. Longterm outcome of anal fistula – A retrospective study. Scientific Reports (2020).