[Complex anal fistulas (author's transl)].

Area of Science:

• Colorectal Surgery
• Proctology

Context:

• Perianal suppurations are common and complex surgical conditions.
• Over 6,500 patient cases inform this study on fistula classification and management.
• Current terminology may not adequately describe fistula complexity.

Purpose:

• To propose a revised classification of perianal fistulas based on their origin and complexity.
• To differentiate between rectal and anal fistulas and their associated risks.
• To guide therapeutic strategies for complex anal fistulas.

Summary:

• The study suggests abandoning the term 'ano-rectal fistula'.
• Fistulas are categorized as rectal (secondary to rectocolonic infection or iatrogenic) or anal (originating from an anal crypt).
• Rectal fistulas present significant risks of postoperative incontinence due to their involvement of the sphincteric apparatus.
• Complex anal fistulas, often iatrogenic or resulting from surgical misadventures, require careful, staged management.
• Antibiotic overuse and technical surgical errors contribute to fistula complexity.

Impact:

• This classification aims to improve diagnostic accuracy and treatment planning for perianal fistulas.
• Understanding fistula origins and complexity can reduce surgical complications, particularly incontinence.
• A staged therapeutic approach is recommended for complex cases, allowing for progressive simplification of fistula tracks.