[Diagnosis and treatment of anal fistula]

Anorectal fistulas can only be cured by operative treatment based on a thorough knowledge of anal anatomy. Recurrences are frequently a result of the surgeon's failure to expose the entire fistula tract out of fear of impaining anal continence. Surgery can provide a permanent cure in 95% of all such cases. Curative treatment of fistulas in patients with colitis, Crohn's disease or AIDS may not be feasible, but some improvement can be achieved. Anal sphincter function should be measured prior to surgery. The anal sphincter is always stronger in males than in females, who are more likely to experience permanent damage of anal continence. This is also true for patients with recurrent disease. Some cases of complicated fistulas are reported.