New Techniques for Treating an Anal Fistula

Surgery for an anal fistula may result in recurrence or impairment of continence.The ideal treatment for an anal fistula should be associated with low recurrence rates, minimal incontinence and good quality of life.Because of the risk of a change in continence with conventional techniques, sphincter-preserving techniques for the management complex anal fistulae have been evaluated.First, the anal fistula plug is made of lyophilized porcine intestinal submucosa.The anal fistula plug is expected to provide a collagen scaffold to promote tissue in growth and fistula healing.Another addition to the sphincter-preserving options is the ligation of intersphincteric fistula tract procedure.This technique is based on the concept of secure closure of the internal opening and concomitant removal of infected cryptoglandular tissue in the intersphincteric plane.Recently, cell therapy for an anal fistula has been described.Adipose-derived stem cells have two biologic properties, namely, ability to suppress inflammation and differentiation potential.These properties are useful for the regeneration or the repair of damaged tissues.This article discusses the rationales for, the estimated efficacies of, and the limitations of new sphincter-preserving techniques for the treatment of anal fistulae.Keywords: Anal fistula; Rectal fistula; Fecal incontinence ing reported in 34 to 63% and 2 to 26% of patients, respectively [10][11][12][13][14]. Cutting seton is also associated with significant morbidity related to discomfort from the seton.Advancement flap is still considered to be the gold standard of treatment for a complex anal fistula.Successful healing of the fistula has been demonstrated in 55 to 98% of patients [8, 10, 15-17].However, this procedure is technically demanding, and although the sphincter mechanism is not divided during advancement flap repair of the fistula, minor incontinence has been found in up to 31% patients and major incontinence in up to 12% of patients [10,18,19].Because of the risk of a change in continence with these conventional techniques, sphincter-preserving techniques for the management of complex anal fistulae have been evaluated.Initial studies of fibrin glue injection for the management of anal fistulae were promising.However, long-term results have been disappointing [20].Glue was easy to apply, but probably not ideal for fistula treatment because of its liquid consistency.A failure of the formed glue clot in a properly sealed tract, the inability to securely fix the material within the tract and the uncertainty of tissue in growth into the glue may all explain the possible causes of the poor outcomes [21].This article aims to review the literature and to identify the new sphincter-preserving techniques, such as the anal fistula plug, the ligation of intersphincteric fistula tract (LIFT) procedure and the cell therapy, used in the management of anal fistulae.